Case manager - rehab

Job Description

Full Time, Days

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to physicians, patients, families, and caregivers
• Leads a population of patients by service line.

The individual’s responsibilities include the following activities:

• a) accurate medical necessity screening and submission for Physician Advisor review,
• b) care coordination,
• c) transition planning assessment and reassessment,
• d) implementation or oversight of implementation of the transition plan,
• e) leading and facilitating multi-disciplinary patient care conferences,
• f) managing concurrent disputes,
• g) making appropriate referrals to other departments,
• h) identifying and referring complex patients to Social Work Services,
• i) communicating with patients and families about the plan of care,
• j) collaborating with physicians, office staff and ancillary departments,
• k) leading and facilitating Complex Case Review,
• l) assuring patient education is completed to support post-acute needs,
• m) timely complete and concise documentation in the Tenet Case Management documentation system,
• n) maintenance of accurate patient demographic and insurance information,
• o) identification and documentation of potentially avoidable days,
• p) identification and reporting over and underutilization,
• q) and other duties as assigned.

Qualifications

Required: Graduate of an accredited school of nursing.

Preferred: Academic degree in nursing (bachelor's or master's)

Required: 2 years of acute hospital case management experience.

Required: RN. Must be currently licensed, certified, or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.

Preferred: Accredited Case Manager (ACM)

Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy.

Join Us

Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Delray Medical Center hospital, we're seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

At Delray Medical Center, 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:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

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

About Us

Delray Medical Center, part of the Palm Beach Health Network, is a 536-bed acute care hospital spanning 30 acres, employing over 1,700 employees, 700 physicians and serving southern Palm Beach County for over 40 years. As both a community hospital and state-designated Level I Trauma Center, Delray Medical Center offers several specialized services including advanced cardiac and vascular facilities, orthopedics, neurosciences, emergency care and weight-loss surgery. Pinecrest Rehabilitation and Outpatient Hospital at Delray Medical Center is the only state designated brain and spinal cord injury rehabilitation program in the county by the State of Florida. Delray Medical Center is also home to Fair Oaks Pavilion, a 53-bed adult psychiatry unit. Come join one of our many teams!