TRA RN Case Manager Utilization Review Ba Sa

Tenet Healthcare - Phoenix, AZ

Full-time - Mid Level

Phoenix, AZ

Hospitals

About the position

The RN Case Manager is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources. This role ensures that care is provided at the appropriate level based on medical necessity, assesses patient transition needs, promotes timely throughput, safe discharge, and prevents avoidable readmissions. The position integrates national standards for case management, including Utilization Management, Transition Management, and Care Coordination, while ensuring compliance with regulatory requirements and providing education to stakeholders.

Responsibilities

• Accurate medical necessity screening and submission for Physician Advisor review
• Care coordination
• Transition planning assessment and reassessment
• Implementation or oversight of implementation of the transition plan
• Leading and facilitating multi-disciplinary patient care conferences
• Managing concurrent disputes
• Making appropriate referrals to other departments
• Identifying and referring complex patients to Social Work Services
• Communicating with patients and families about the plan of care
• Collaborating with physicians, office staff, and ancillary departments
• Leading and facilitating Complex Case Review
• Assuring patient education is completed to support post-acute needs
• Timely complete and concise documentation in Case Management system
• Maintenance of accurate patient demographic and insurance information
• Identification and documentation of potentially avoidable days
• Identification and reporting over and underutilization
• Other duties as assigned

Requirements

• Graduate of an accredited school of nursing
• 2 years of acute hospital case management experience
• RN license, currently licensed, certified or registered to practice as required by law or regulation in state of practice

Nice-to-haves

• Academic degree in nursing (bachelor's or master's)
• Tenet hospital case management experience
• Accredited Case Manager (ACM)

Benefits

• Competitive salary
• Comprehensive health insurance
• Retirement savings plan
• Paid time off
• Continuing education opportunities