PRN Case Manager II

ScionHealth; Pennsylvania; Hybrid; USD 65,000 - 90,000; Full time

Job summary

Kindred Hospital Philadelphia - Havertown and Acute Rehabilitation Unit (ARU) seeks a skilled care coordinator to optimize patient outcomes through effective collaboration with the ICT team, discharge planning, and utilization management across the care continuum.

You will assess patient needs, coordinate with physicians, payors, and post-acute providers, and advocate for cost-effective, high-quality care while ensuring compliance with regulatory standards.

Qualifications

• Must hold RN license instate practice.
• Must have 2+ years healthcare experience with case management or discharge planning.
• Knowledge of Medicare/MD regulations and reimbursement processes.

Responsibilities

• Coordinates and facilitates care with the Interdisciplinary Care Transitions team.
• Monitors patient stays for effective care coordination.
• Conducts comprehensive discharge planning.
• Participates in rounds to review goals and resource use.
• Collaborates with physicians, payors, and post-acute providers.
• Advocates for patients and families to support informed decisions.

Skills

RN license

Discharge planning

Case management

Utilization review

Interdisciplinary collaboration

English fluency

Critical thinking

Healthcare experience

Communication skills

Microsoft Office

Education

Postsecondary nursing program

BSN/MSN/BSW/MSW

Tools

MS Office

Job description

Description

Kindred Hospital Philadelphia - Havertown and Acute Rehabilitation Unit (ARU) is 66-bed hospital offering the same in depth care you would receive in a traditional hospital, but for an extended recovery period. With 57 long-term acute care(LTAC) hospital beds, we partner with your physician and offer 24-hour clinical care seven days a week so you can start your journey to wellness. Similarly, our nine-bed ARU is designed for people who have experienced the debilitating effects of an acute injury, impairment or illness. We are located in within a medical district close to Darby Creek and West Chester Pike expressway.

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions

• Care Coordination Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high risk patients who would benefit from additional support.
• Serves as a patient advocate.
• Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions.
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs.
• Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
• Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients’ care throughout the care continuum.
• Discharge Planning Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning.
• Provide comprehensive discharge planning for each patient.
• Utilizes critical thinking to develop and execute effective discharge planning.
• Coordinate and communicates with patient/family efficient and effectively.
• Utilization Management Conducts medical necessity review for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.
• Other Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
• Approximate percent of time required to travel: 0%
• Must read, write and speak fluent English.
• Must have good and regular attendance.
• Performs other related duties as assigned.

Qualifications

Education

• Postsecondary (Cert/Diploma/Program Grad) from an accredited school of nursing (Required) And
• Bachelor’s Degree in nursing or social work: BSN, MSN, BSW or MSW (Preferred)

Licenses/Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of practice Upon Hire (Required) Or
• LCSW- License Clinical Social Worker LCSW or LSW Upon Hire (Required) Or
• CSWCM - Social Work Case Manager Certification Upon Hire (Preferred)

Experience

• 2+ years experience in healthcare setting (Required) And
• Prior Experience in case management, utilization review, or discharge planning (Preferred)