Case Manager - RN (Casual), St. Vincent

Allegheny Health Network; Erie (Erie County); On-site; USD 75,000 - 95,000; Full time

Job summary

St. Vincent Hospital seeks a Registered Nurse to coordinate care and manage transitions across care levels. You will promote collaboration, ensure appropriate access and optimize resource use while supporting patient satisfaction and reimbursement.

The role requires nursing licensure and strong communication with providers, patients, and families, with emphasis on care coordination excellence.

Qualifications

• Bachelor’s Degree in Nursing or Nursing Diploma with experience in care management.
• 3 years in a clinical nursing role.
• Current RN licensure in PA or multi-state via eNLC.

Responsibilities

• Assess patient needs for effective transition of care planning.
• Coordinate continuum of care with the health care team.
• Document data to monitor interventions and outcomes.

Skills

Care coordination

Clinical nursing

Communication

Team collaboration

Education

Bachelor's degree in nursing

Nursing diploma alternative

3 years clinical nursing

Job description

St. Vincent Hospital is a Magnet®-designated hospital for excellence in nursing, serving the people in the Lake Erie region since 1875 with a quality of care and service second to none!

Allegheny Health Network is a 9-hospital system part of Highmark Health, transforming healthcare by providing highly effective services to customers, patients and communities. The organization values inclusion, fresh perspectives, and offers growth and educational opportunities to employees.

General Overview

Registered nurse who is proficient in the coordination of care and manages coordination of care in accordance with recognized standards of practice for Care Management. Professional role model utilizing expertise in care management to promote a collaborative professional environment that supports excellence of care and achievement of optimal resource utilization. Also facilitates appropriate LOS, patient satisfaction and reimbursement for all patients.

Essential Responsibilities

• Assumes role in assessment of patient physical, psychosocial, and economic needs for effective transition of care planning to a variety of levels of care.
• In collaboration with the care team, facilitates the development and communication of the continuum of care transition plan to appropriate health service providers.
• Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes. Interviews and collects patient specified data and chart review related to readmission.
• Knowledgeable of and complies with accreditation and regulatory requirements. Integrates performance improvement principles and customer service principles into all aspects of job responsibilities.
• Obtains or ensures acquisition of appropriate pre-certification authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party guidelines. Obtains or facilitates acquisitions of urgent/emergent authorizations, continued stay authorizations and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements.
• Documents, monitors, intervenes/resolves and reports clinical denials/appeals and retrospective payer audit denials. Collaboratively formulates plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor and third party payers.
• Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to the policies, procedures, rules, regulations and laws of the hospital and all federal and state regulatory bodies. Communicates telephonically and electronically with the outpatient providers in an effort to enhance the continuum of care.
• Assumes responsibility for AHN required continued education and own professional growth.
• Performs other duties as assigned or required.

Qualifications

Minimum

• Bachelor’s Degree in Nursing -OR- Bachelor’s Degree and Nursing Diploma -OR- 6 years of relevant experience in lieu of a degree
• 3 years in a clinical nursing role
• Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Critical thinking and problem solving
• Flexibility and adaptability to change
• Strong communication and collaboration skills with ability to tailor style according to target audience (providers, peers, clinical team members, patients, families)

Preferred

• Nationally recognized Case Management Certification
• Transition planning and understanding of community and facility resources
• Knowledge of motivational interviewing techniques
• BSN

Licenses or Certifications

Required

• None

Preferred

• ACM Certification (Accredited Case Manager) - American Case Management Association
• Case Management - American Board of Occupational Health Nurses (ABOHN) and Certified Case Manager (CCM)
• Commission for Case Manager Certification (CCMC)

Equal Employment Opportunity

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.