Registered Nurse Case Manager (RN)

Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Overview We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Our Story We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. We have a rich history at Tenet. There are so many stories of compassionate care; so many "firsts" in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others. Our Impact Today Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions. Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day. Job Summary San Ramon Regional Medical Center began serving residents of the San Ramon Valley and its surrounding communities in 1990. Located on a hillside overlooking the valley, we are a 123‑bed, acute‑care hospital, primary stroke center, and cardiac heart surgery hospital. San Ramon Regional Medical Center provides comprehensive inpatient and outpatient services. Personalized service and a patient‑centered philosophy are distinctive qualities of our facility. We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions. Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services Wellbeing support, including employee assistance program (EAP) Time away from work programs for paid time off, long‑ and short‑term plan coverage Savings and retirement including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well‑being counseling Education support through tuition assistance, student loan assistance, certification support, and online educational program Additional benefits life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program Registered nurses – Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelines Benefits may vary by location and role Responsibilities In this role, you will 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. Utilization Management – Support medical necessity and denial prevention, promote appropriate length of stay, readmission prevention, and patient satisfaction. Transition Management – Promote appropriate length of stay, readmission prevention and patient satisfaction. Care Coordination – Demonstrate throughput efficiency while assuring care is the right sequence and at appropriate level of care. Compliance – Adhere to state and federal regulatory requirements, TJC accreditation standards and Tenet policy. Education – Provide education to physicians, patients, families and caregivers. Specific activities include accurate medical necessity screening, care coordination, transition planning assessment and reassessment, implementation of transition plans, leading multidisciplinary patient care conferences, managing concurrent disputes, making referrals, communicating with patients and families, collaborating with physicians and ancillary departments, leading Complex Case Review, ensuring patient education, concise documentation, maintaining patient demographics and insurance information, identifying avoidable days, reporting utilization, and performing other duties as assigned. Primary Information, Tools and Systems Used Patient data – hospital admission, discharge, transfer system Healthcare staff documentation related to patient care Regulatory and payor requirements Allscripts® Care Management System McKesson Care Enhance Review Manager (CERMe) InterQual system Clinical data interface and secure faxing Patient Medical Record including Cerner and HPF Hospital specific Clinical Software Qualifications Minimum Education: Graduate of Accredited School of Nursing (BSN preferred). Minimum Experience: At least two (2) years of recent case management acute hospital experience or a Masters Degree in case management. Skills: 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. Licenses/Certificates/Credentials: Current California Registered Nurse license. Accredited Care Manager (ACM) or Certified Case Manager (CCM) preferred. Physical Demands: Per Job Functional Match description. Work Environment: Individual works in a fast‑paced clinical and office environment. Training Requirements Must complete Tenet’s InterQual education course within 30 days of hire (and at least annually thereafter) and pass with a score of 85 or better. Must complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire. Completion of Compass Directional Training within 90 days of hire. Attendance at hospital and department orientation is required. The orientation includes review of Tenet Case Management and compliance policies, InterQual®, Transition Management, Utilization Management, and other case‑management topics. Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law. Equal Employment Opportunity Statement 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. Tenet participates in the E‑Verify program. #J-18808-Ljbffr Tenet Healthcare