Case Manager, RN PRN Days - Baylor Scott & White Medical Center - Sunnyvale

Baylor Scott & White Medical Center - Sunnyvale is an acute care hospital serving the communities in and around Sunnyvale, Texas. We strive to make the lives of our patients and their families better at every interaction. Our Team Members live out this passion in their daily roles as we support their career and personal goals.

We are located just minutes east of Dallas and south of Garland / Rowlett on Hwy 80 at Collins Road in Sunnyvale. Many team members live in Forney, Mesquite, Garland, Balch Springs, and Rockwall areas with a short commute.

Our work environment includes:

• Modern Office Setting
• On-Site Cafe' and Coffee Bar (Payroll Deduction available)
• Collaborative Teams
• Team Member engagement opportunities
• Competitive pay
• Benefits provided based on your work assignment (Full-time, Part-time, or PRN)

Baylor Scott & White Medical Center - Sunnyvale is seeking a Case Manager RN I to assess, plan, implement and evaluate the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

What your day will look like:

• Responsible for performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments.
• Responsible for assessment of all aspects of patient care in an effort to optimize patient safety and reduces the likelihood of medical/health care errors.
• Able to communicate with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.
• Is knowledgeable of criteria for Medicare, Medicaid, Commercial and private insurance coverage.
• Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed.
• Communicates daily with admissions personnel regarding admissions and discharges to various units, when applicable.
• Initiates ongoing communication with the patient and patient’s family to assess discharge needs.
• Treats patients and families with respect and dignity.
• Communicates with family members and caretakers regarding the needs of the patient and anticipated plans.
• Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
• Documents discharge planning in an ongoing manner.
• Is knowledgeable of patient’s financial status, diagnosis and discharge needs.
• Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
• Acts on performance improvement issues identified during CQI meetings.
• Cooperates with Case Manager’s activities with insurance company, based on information received.
• Maintains and respects confidentiality of patient/physician/personnel information
• Collaborates with the Business Office Manager and onsite eligibility worker, where patients require such assistance.
• Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
• Actively participates in Utilization Management Committee, CQI, varying team meetings and other meetings as appropriate.
• Demonstrates an ability to be flexible, organized and function under stressful situations.
• Maintains a good working relationship both within the department and with other departments.
• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
• Documentation meets current standards and policies.

Success Factors:

• Current Registered Nurse licensure in State of Texas.
• Is a motivated, independent individual who can organize workload so that all functions are completed appropriately.
• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Experience in providing patient care.
• Ability to read and communicate effectively in English.
• Additional languages preferred.
• Basic computer knowledge

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.