Summary

The Case Management Coordinator is responsible to conduct medical necessity screening and work collaboratively with the interdisciplinary team to provide care coordination for patients under the direction of a Registered Nurse and in compliance with evidence-based practice and regulatory requirements.
The Case Management Coordinator complies with the scope of services defined by the Licensed Vocational /Practical Nurse LVN/LPN state licensure requirements.
The Case Management Coordinator 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.

Responsibilities

The Case Management Coordinator's responsibilities include the following activities:

• Accurate medical necessity screening and submission for Physician Advisor review

• Care coordination

• Implementation of the transition plan based on RN Case Manager and/or Social Worker (SW) assessment(s)

• Communication with interdisciplinary team during patient care conferences

• Management of concurrent disputes

• Communication with patients and families regarding the plan of care established by RN, SW and Physician

• Collaboration with physicians, office staff and ancillary departments

• Clear, complete and concise documentation in electronic system

• Maintenance of accurate patient demographic and insurance information

• Identification and documentation of potentially avoidable days

• Identification and reporting of over and underutilization

• And other duties as assigned

Education

LPN

Experience

Required: 2 years patient care experience

Certifications

Required: The Case Management Coordinator must be currently licensed, certified or registered to practice profession as required by law, regulation in state of practice or policy.

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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.