Registered Nurse (RN) - Case Management
Baptist Medical Center
San Antonio, TX
3x12 hrs

POSITION SUMMARY

The individual in this position works under the direction of the RN and/or Social Worker to complete referrals for post-acute services for patients, and assists with tasks that do not require a clinical license or degree. The individual’s responsibilities include the following  activities: a) arrange post-discharge services; b) create and follow up on electronic referrals using the Tenet Case Management system; c) review patient choice letters with patients/families for required signatures; d) provide follow up Important Message to Medicare 
patients prior to discharge; e) communicate with patients, families and other members of the care team; f) complete tasks assigned by Case Manager and Social Work staff; g) make copies, send faxes and complete phone calls; h) complete process reviews or audits as requested; and i) other duties as assigned. 

General Functions:
Utilization Management
 Validates patient’s demographic and payer information with patient/family and notifies Patient 
Access immediately if any corrections are needed within 24 hours of admission
 Validates that all commercial/managed care discharge have an authorization for status and level of 
care provided and notifies Director of Case Management (DCM) or designee of variances
 Escalates discharged cases at end of the day that have no authorization or notification or dispute is 
provided by payor.
 Ensures, on a concurrent basis, that all clinical needed by payors and updates are provided by 100% alerting Case Manager assigned to case and escalating to DCM if not complete timely
 Trends dispute/denial potential to DCM or designee by failure points to revenue cycle
 Prepares denial information for UR Committee, Denial and Revenue Cycle Meetings
 Collaborates with Patient Access, Case Management, Managed Care and Business office to improve 
concurrent review process to avoid denial or process delays in billing accounts.

Transition Management
 Follows up on Authorization for post-acute services
 Makes referrals for post-acute services under the direction of the RN Case Manager or Social (SW) 
staff utilizing the Tenet Case Management documentation system..
 Follows-up if referral requires authorization by payor to discharge the patient
 Completes tasks as assigned by RN or LVN Case Manager and/or SW staff
 Makes copies, sends faxes and complete phone calls to arrange post-acute services and to ensure that 
appropriate hospital information is communicated to post-acute serviced and to ensure that 
appropriate hospital information is communicated to post- acute providers
 Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet  policy
 Provides Important Message follow-up letters to Medicare beneficiaries per Tenet policy and under 
the direction of the RN Case Manager or SW Compliance
 Adheres to federal, state, and local regulations and accreditation requirements impacting case  management scope of services
 Adheres to department structure and staffing ,policies and procedures to comply with the CMS Conditions of Participation and BHS/Tenet policies

Other:
 Utilizes resources efficiently and effectively
 Maintains safe environment
 Participates in Performance Improvement activities

MINIMUM EDUCATION: High School diploma or equivalent
PREFERRED EDUCATION: Associate’s or Bachelor’s Degree from an accredited college 
MINIMUM EXPERIENCE: 2 years of experience in clerical or healthcare field. Possesses excellent organizational, 
verbal/ written communication skills, problems solving and computer literacy skills. Data Analytics skills.
PREFERRED EXPERIENCE: Acute hospital experience
REQUIRED CERTIFICATIONS/LICENSURE: NA
PREFERRED CERTIFICATIONS/LICENSURE: Paramedic, EMT or Nursing Assistant certifications.
REQUIRED COURSES/ COMPLETIONS (e.g., CPR): NA

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