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Responsible to facilitate care along a continuum through effective resource coordination to help patient achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination. Has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to provide timely throughput, safe discharge and prevent avoidable readmissions. Integrates the national standards forcare 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 efficient throughput while assuring care is sequenced 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. Completes established competencies for the position within designated introductory period. Other related duties as assigned