Registered Nurse (RN) - Case Management

Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters! 

Benefits Statement

At Tenet Healthcare, 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 (PTO)  
• 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

Job Summary / Description

The individual in this position is responsible to facilitate 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 provided is at the appropriate level of care based on medical necessity. This position manages the medical necessity process for accurate and timely payment for services that may require negotiation with a payor on a case-by-case basis. This position integrates national standards for case management scope of services including:

• Utilization Management services supporting medical necessity and denial prevention
• Coordinating with payors to authorize appropriate level of care and length of stay for medically necessary services required for the patient
• Collaborating with Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at the appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Educating payors, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits and compliance

The individual’s responsibilities include the following activities:

1. Securing and documenting authorization for services from payors
2. Performing accurate medical necessity screening and timely submission for Physician Advisor reviews
3. Collaborating with payors, physicians, office staff and ancillary departments
4. Managing concurrent disputes
5. Identification and reporting over and underutilization
6. Timely, complete, and concise documentation in Tenet Case Management documentation system
7. Maintenance of accurate patient demographic and insurance information
8. Identification and documentation of potentially avoidable days
9. Other duties as assigned.

POSITION SPECIFIC RESPONSIBILITIES:

Utilization Management<