San Ramon, CA30+ days ago
Monitors to ensure case management staff document in the Tenet Case Management documentation system to communicating information through clear, complete and concise documentation (20% daily, essential) Care Coordination • Works with Nursing and hospital leadership to ensure Patient Care Conferences and Complex Case Review processes are in place to promote timely and appropriate throughput • Participates in daily bed management meeting to support timely and effective patient placement and transfer within the hospital • Monitors to ensures that patients have a plan of care that is clinically appropriate, consistent with patient preference & choice and available resources • Monitors to ensures consults, testing and procedures are sequenced to support clinical needs with timely and efficient care delivery • Ensures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient plan of care • Effectively collaborates with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes (20% daily, essential) Education • Provides education to physicians regarding medical necessity, complete and accurate documentation, and compliance with related regulatory requirements • Prepares and provides data to physicians and the hospital on utilization of resources • Provides education to case management staff, physicians and the healthcare team relevant to the o Effective progression of care, o Appropriate level of care, and o Safe and timely patient transition (10% daily, essential) Compliance • Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services • Ensures that the department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies • Operates within the RN scope of practice as defined by state licensing regulations • Implements and monitors compliance with Tenet Case Management practices (10% daily, essential)Qualifications Required: Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW. (20% daily, essential) Transition Management • Implements and monitors process to ensure that a transition plan assessment is completed within 24 hours of patient admission to identify and document the anticipated transition plan for patients • Ensures case management staff use electronic referral request process for patient placements • Monitors to ensure that patient preference & choice is documented per CMS regulations and Tenet policy • Identifies and reports variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements.