Part-Time RN Case Manager: Care Transitions & Payer Support

IntelliResume; Monroeville (Allegheny County); On-site; USD 45,000 - 65,000; Part time

Job summary

Highmark Health is seeking a part-time RN Case Manager for Forbes Hospital in Monroeville, PA to coordinate patient care and transitions in accordance with established standards. The role requires a Bachelor’s degree in nursing and at least 3 years of clinical nursing experience, with PA RN licensure or multi-state licensure (eNLC) preferred.

You will assess needs, develop care transition plans, document data, obtain pre-certifications, and support utilization review while upholding

Qualifications

• Bachelor's Degree in Nursing required, 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 required.
• Current State of PA RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) required.
• Preferred: Nationally recognized Case Management Certification.

Responsibilities

• Assess patient physical, psychosocial, and economic needs for effective transition of care planning.
• Collaborate with the care team to develop and communicate the continuum of care transition plan.
• Document, verify, and validate specific data to monitor and evaluate interventions and outcomes.
• Interview and collect patient-specific data and conduct chart reviews related to readmission.
• Ensure compliance with accreditation and regulatory requirements.
• Integrate performance improvement and customer service principles into job responsibilities.
• Obtain pre-certification authorizations from third-party payers prior to hospitalization.
• Facilitate acquisitions of urgent/emergent authorizations and continued stay authorizations.
• Document, monitor, and report clinical denials/appeals and retrospective payer audit denials.
• Serve as an educational resource regarding utilization review practices and payer guidelines.

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a part-time RN Case Manager for Forbes Hospital in Monroeville, PA to coordinate patient care and transitions in accordance with established standards. The role requires a Bachelor’s degree in nursing and at least 3 years of clinical nursing experience, with PA RN licensure or multi-state licensure (eNLC) preferred.

You will assess needs, develop care transition plans, document data, obtain pre-certifications, and support utilization review while upholding