Case Manager - RN (Full Time), St.Vincent

Highmark Health; Federal Hill (PA); On-site; USD 80,000 - 110,000; Full time

Job summary

Allegheny Health Network is seeking a Nurse Case Manager to create and evaluate care plans across the health continuum, collaborating with providers, clinical teams, and external partners to optimize outcomes and resource use.

The role requires a BSN (or equivalent), PA RN licensure, and strong communication skills; CCM certification is preferred, with ongoing professional development encouraged.

Qualifications

• Minimum Bachelor’s Degree in Nursing or equivalent
• 3 years in a clinical nursing role
• Current State of PA RN licensure OR multi-state licensure via eNLC
• Strong assessment and analytical skills
• Excellent communication and collaboration abilities
• Preferred CCM certification or equivalent

Responsibilities

• Contributes to/ completes comprehensive assessment of patients and families.
• Identifies barriers and analyzes transition plans and care coordination.
• Coordinates clinical care with patient, family, providers, and inter-disciplinary team.
• Advocates for patients with providers, payers, and post-acute partners.
• Educates patients, families, and teams on care, documentation, and utilization principles.
• Pursues professional development and participates in committees.

Skills

Case Management

Nursing

Clinical assessment

Care coordination

Communication

Education & training

Education

Bachelor's Degree in Nursing

RN licensure (PA eNLC preferred)

Job description

Company : Allegheny Health Network

Job Description : St. Vincent Hospital

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 At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities.

AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees.

General Overview

This job has responsibility for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum. Incumbents will utilize nationally recognized standards of practice for case management by collaborating with providers, clinical teams, health plans, and external partners while advocating for patients and caregivers in order to align goals and plans. Incumbents will serve as professional role models, utilizing their expertise in care management to promote a collaborative professional environment that optimizes outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization. Serves as key team members in the management of readmissions, length of stay, ED utilization, and patient/family satisfaction.

Essential Responsibilities

• Contributes to or completes comprehensive assessment of patients and their families/caregivers, inclusive of clinical/physical needs, social determinants of health, and economic barriers impacting their ability to manage their health. (20%)
• Effectively identifies barriers and analyzes situations for assigned patient population, including risk for admission/readmission, external resources, and patient/family capacity in order to determine safe plans for transition and care coordination. (20%)
• Coordinates the clinical care with the patient, family, provider(s), and members of the interdisciplinary team. (25%)
• Advocates for patients and families through effectively communicating with providers, interdisciplinary team members, payers, and post-acute partners to assure effective outcomes and care. (15%)
• Leverage understanding of industry standards to provide applicable education to patients, families, providers, and interdisciplinary team partners including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%)
• Actively seeks professional development opportunities through professional certification, mentoring/precepting, and/or participation on department/hospital/system committees. (5%)
• Adheres to the policies, procedures, rules, regulations, and requirements of hospitals and other clinical settings. (5%)

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

Additional Employment Requirements

• CPR – American Heart Association Act 34 Criminal Background Clearance Certificate Act 33 Child Abuse Clearance Certificate Act 73 FBI Fingerprinting Criminal Background Clearance Certificate Professional Certification within 5 years of start date. Incumbents in role as of 12/1/2022 have until 12/31/2026 to obtain Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 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. California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.