Registered Nurse - Case Management

Prime Healthcare; Philadelphia, Northern (Philadelphia County, KY); Hybrid; USD 68,000 - 95,000; Full time

Job summary

Roxborough Memorial Hospital in Philadelphia, part of Prime Healthcare, seeks a qualified registered nurse with case management experience to join our full-time team. The role emphasizes admission quality, resource management and collaboration across care teams.

Responsibilities include leading discharge planning, applying Milliman and InterQual criteria, and ensuring safe, cost-conscious patient transitions in a compassionate community hospital setting.

Qualifications

• Minimum 5 years work experience post-graduation and an active RN license.
• Five years acute care nursing experience preferred; at least one year in case management, discharge planning or nursing management.
• Current BCLS (AHA) certificate on hire and maintain current.
• Knowledge of Milliman Criteria and InterQual Criteria preferred.
• Basic to intermediate computer skills.
• Behavioral Violence Prevention Training within 3 months of hires and current.

Responsibilities

• Responsible for quality and resource management of all admitted patients across the care continuum.
• Promote cost containment and coordinate with health care providers to ensure seamless care delivery.
• Perform holistic admission and concurrent review of medical records for medical necessity, intensity of service and illness severity.

Skills

RN license

Case management experience

Discharge planning experience

Nursing management experience

Computer skills

Behavioral Violence PreventionTraining

Education

RN license (state)

AHA BCLS certificate

Tools

Milliman Criteria

InterQual Criteria

Job description

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Roxborough Memorial Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Roxborough Memorial Hospital is a 131-bed community hospital. The hospital has been serving the medical and health care needs of the Roxborough, Manayunk, East Falls and northwest section of Philadelphia communities for more than a century, having first opened its doors in 1890. Roxborough Memorial Hospitals School of Nursing has been educating nurses since 1898. The hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency.

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

1. Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.

2. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.

3. Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.

4. Current BCLS (AHA) certificate upon hire and maintain current;

5. Knowledge of Milliman Criteria and InterQual Criteria preferred.

6. Experience and knowledge in basic to intermediate computer skills.

7. Behavioral Violence Prevention Training within 3 months of hires and maintain current.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights:https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf