Registered Nurse (RN) - Case Management

Job Description

Detroit Medical Center is seeking a Registered Nurse (RN) Case Management for a nursing job in Detroit, Michigan.

Job Description & Requirements

• Specialty : Case Management
• Discipline : RN
• Duration : Ongoing
• 36 hours per week
• Shift : 12 hours
• Employment Type : Staff

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Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At DMC Detroit Receiving Hospital , we’re seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

Benefits Statement

At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include :

Note : Eligibility for benefits may vary by location and is determined by employment status

Summary Description

Oversees hospital utilization performance improvement and operational management of the site Case Management Department to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services.

Integrates national standards for case management scope of services including :

Responsibilities include the following activities : a) manages department operations to assure effective throughput and reimbursement for services provided, b) leads the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensures medical necessity review processes are completed accurately and in compliance with CMS regulations and Tenet policy, d) ensures timely and effective patient transition and planning to support efficient patient throughput, e) implements and monitors processes to prevent payer disputes, f) develops and provides physician education and feedback on hospital utilization, g) ensures compliance with state and federal regulations and TJC accreditation standards, and h) other duties as assigned.

Drafts policy provisions and provides interpretation of department policies, in accordance with the DMC Utilization Review Plan. Identifies the need for and drafts or defines procedures / protocols in collaboration with higher management input, goals, and objectives; modifies procedures / protocols, as necessary. Monitors the quality and productivity of staff to ensure work is completed. Implements performance improvement activities to insure consistency and safety within departmental activities. Initiates or recommends personnel actions such as hires, fires, disciplines, etc. Completes performance appraisals and ensures competency of staff. Assists in the development of daily, monthly, and / or yearly goals and measures for department, and as requested, assists in assessment of goal attainment. Assists in developing and monitoring budget. Monitors activities for and ensures compliance with laws, government regulations, Joint Commission requirements and DMC policies relating to areas of responsibility. As directed, implements external and internal audit recommendations.

POSITION SPECIFIC RESPONSIBILITIES :

Department Operations

Utilization Management

 Implements and monitors processes to ensure medical necessity review processes are in place for patients to be in the appropriate status and level of care per Tenet policy.

 Oversees submission of cases to Physician Advisor review to ensure timely referral, follow up and documentation.

 Implements and monitors utilization review process in place to communicate appropriate clinical data to payers to support admission, level of care, length of stay and authorization for post-acute services.

Transition Management

Care Coordination

Education

o Effective progression of care,

o Appropriate level of care, and

o Safe and timely patient transition

Compliance

Qualifications :

Minimum Qualifications

1. Bachelor’s degree in Nursing or other health-related field, or the equivalent combination of education and / or related experience or Master’s in Social Work for MSW. Master’s degree in Nursing, Business Administration or Hospital Administration preferred.

2. Registered Nurse or LCSW / LMSW license. Must be currently licensed, certified, or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW / LMSW license for state(s) covered.

3. Three to five years of acute hospital case management leadership experience. Five years acute hospital case management experience preferred. McKesson InterQual® experience preferred. Business planning experience preferred.

4. Accredited Case Manager (ACM) preferred.

Skills Required

1. Analytical ability to serve in an advisory / consultative role in determining and / or developing strategies, policies, processes, protocols and methods, frequently in the absence of guidelines or technical assistance, and to evaluate and direct complex systems that foster innovative approaches to procedures / processes.

2. Fiscal skills to monitor and control costs and revenue.

3. Ability to cope with stressful situations, manage multiple and sometimes conflicting priorities simultaneously.

4. Strong communication and interpersonal skills for frequent contacts with internal customers as well as stakeholders external to the DMC to persuade or negotiate on a wide range of subjects in situations which may be controversial, sensitive and / or lead to confrontation. A mastery of a variety of communication modalities is required to include leading meetings, making formal presentations, and writing complex documents and managing complex relationships over time.

5. Teaching abilities to conduct educational programs for staff.

6. Project management skills including the ability to define program, project, or process objectives, identify stakeholders and their interests, plan steps, coordinate and allocate human, technological and fiscal resources to accomplish goals and objectives in a resourceful yet timely manner.

7. Leadership skills including demonstrated willingness to pursue leadership roles with increasing levels of accountability, comfort with decision-making responsibilities, coaching, teaching and counseling skills, and the ability to inspire and build confidence in others and to forge alliances and garner support.

8. Technical knowledge of community resources, regulatory requirements, reimbursements, and utilization management procedures in order to function

Facility Description

DMC Detroit Receiving Hospital, Michigan’s first Level I Trauma Center, helped pioneer the evolution of emergency medicine and currently has one of the busiest and most well-equipped emergency departments anywhere. The first and largest verified burn center in the state is at Receiving, and it is one of only 43 in the nation. Receiving also offers the state’s leading 24 / 7 hyperbaric oxygen program, Metro Detroit’s first certified primary stroke center, and the nationally recognized and accredited DMC Rosa Parks Geriatric Center of Excellence.

EEO Statement :

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.

Tenet participates in the E-Verify program.

Follow the link below for additional information.

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Job : Case Management Primary Location : Detroit, Michigan Facility : DMC Receiving Hospital Job Type : Full Time Shift Type : Day

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual or...