Up to $12,500 Sign-On bonus based on experience
Desert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint replacement & spinal surgery, neurosurgery, ICU, Telemetry, step-down care, skilled nursing, as well as outpatient therapy, hand and lymphedema clinics.
GENERAL DUTIES:
The individual in this position has overall responsibility for overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning.
The individual's responsibilities will include, but not be limited to the following activities: a) medical necessity screening b) care coordination c) discharge planning d) facilitating multi-disciplinary patient care conferences e) managing concurrent disputes f) making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST) g ) referring complex social issues to Social Service h ) communicating with patients and their families about the plan of care i) collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy) j) participating in weekly Complex Case Review k) arranging for post -discharge patient education l) clear, complete and concise documentation in eCCM m ) maintaining accuracy of patient demographic and insurance information n) identifying and documenting potentially avoidable days o) identifying and reporting over and under utilization o) and other duties as assigned.
Attends hospital workshop led by the Director of Case Management or designee that includes the Tenet Case Management Model, InterQual, Discharge Planning, Utilization Management, and other topics specific to case management. Extended orientation with selected Case Managers may occur.
Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements
Software used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, Hospital specific Clinical Software
DEPARTMENT SPECIFIC DUTIES:
Priority 1: Coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (40% daily, essential).
Priority 2: Identify and report variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes work with relevant software and communicating information through clear, complete and concise documentation in eCCM (40% daily, essential).
Priority 3: Effective collaboration with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes (10% daily, essential).
Priority 4. Remain current with relevant clinical/case management practices. (10% daily, essential).
The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist.
InterQual reviews
Observation hours
Excess Days/ALOS
Clinical disputes - incidence and dollars
Number and type of avoidable days
Resource Utilization
At least 5 hours of CEUs per year on topics related to Case Management
POSITION QUALIFICATIONS:
Required:
Must have 5 years CM experience in an acute care setting; planning and executing post acute care discharges.
Proficient in utilization review and care coordination within a NICU environment.
Knowledgeable of available resources for post acute discharge.
Demonstrated ability to effectively utilize Allscripts case management software.
Strong understanding of medical terminology, procedures, and documentation practices specific to neonatal care.
Excellent communication skills, both written and verbal, with the ability to interact effectively with multidisciplinary teams, patients, and families.
Proven track record of conducting thorough assessments, developing care plans, safe discharge plans, and ensuring appropriate utilization of resources for neonatal patients.
Ability to provide and manage multiple tasks efficiently in a fast-paced environment.
Detail-oriented with a commitment to accuracy and compliance with regulatory standards and organizational policies.
Experience collaborating with insurance providers and external healthcare agencies to facilitate optimal patient outcomes and resource utilization.
Current California RN licensure.
Preferred:
B.S.N. preferred
PHYSICAL REQUIREMENTS:
While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee is frequently required to use fine motor skill (typing/data entry), and reach with hands and arms. The employee is frequently required to stand; walk; and occasionally stoop, kneel, or crawl. The employee must regularly lift and /or move up to 20 pounds and occasionally lift and/or move up to 50 pounds. Individual works in a clinical and office environment.
Shift:
Schedule: Monday thru Friday
Pay Range: $54.81 - $84.23 hourly
Individual wages are determined based upon a number of factors including, but not limited to, an individual's qualifications and experience
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
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.
