Registered Nurse (RN) - Case Manager

Lifepoint Health®; Johnstown (Cambria County); On-site; USD 70,000 - 90,000; Part time

Benefits offered by this job

Comprehensive medical, dental, and vision coverage

401(k) retirement package and company match

Career growth with tuition assistance

Job summary

Lifepoint Health® is seeking a Utilization Management RN Case Manager in Johnstown, PA. This role involves ensuring accurate clinical documentation, regulatory compliance, and effective case management in collaboration with an interdisciplinary team.

The ideal candidate has a current RN license, acute-care experience, and a commitment to patient care. Comprehensive benefits are offered, including financial protection and career growth opportunities.

Qualifications

• Current state RN license is required.
• Minimum 3 years of acute-care experience as a professional nurse.
• Previous case management experience preferred.

Responsibilities

• Ensure accurate clinical documentation and regulatory compliance.
• Review patient records to validate Severity of Illness and Intensity of Service.
• Communicate clinical information to managed care organizations.

Skills

Case management functions

Care coordination

Clinical documentation

Patient interaction

Education

Associate or bachelor’s degree from an accredited nursing school

BLS certification

Job description

Job Type

PRN | M-Sun 8a-4:30p

About the Role

The Utilization Management RN Case Manager (UM-RNCM) works under the direction of the Case Management Manager and plays a critical role in ensuring accurate clinical documentation and regulatory compliance. The UM-RNCM performs initial clinical reviews of assigned patient records to validate Severity of Illness and Intensity of Service using industry-standard criteria (MCG). Cases that do not meet criteria are escalated to Physician Advisors, with ongoing follow-up to ensure appropriate utilization and compliance. The UM-RNCM also communicates clinical information to managed care organizations to secure authorization for services and reimbursement, ensures accurate patient status throughout the hospital stay, and collaborates closely with physicians to address and resolve any denial determinations.

Responsibilities

• Skilled in case management functions and care coordination.
• Utilizes Interqual or the 2MN rule to determine status for all patients assigned an acute care bed.
• Reviews medical records and provides accurate clinical information to payers for authorization.
• Collaborates with interdisciplinary team to facilitate progression of care and resource utilization.
• Proactively interacts with patients and families during the admission process to set expectations for the course of stay and length of stay.
• Proactively analyzes information from the care team to support inpatient admission.
• Assesses, identifies, and intervenes to reduce the risk of barriers that will interfere with the transition of care.
• Facilitates optimal care transition to reduce avoidable readmissions.
• Follows the case management policy & procedure for utilizing Physician Advisors.
• Interacts with attending physicians, physician advisors, and department chairs regarding any identified quality or utilization issues.
• Leads interdisciplinary discharge planning rounds (IDTs) to determine appropriate concurrent care planning, resource utilization, and post-acute level of care determination.
• Identifies and documents avoidable days and intervenes promptly to remove identified barriers.
• Follows CMS and regulatory requirements for case management processes.
• Coordinates concurrent denial/appeal (peer-to-peer) process for assigned cases.
• Assumes on-call and weekend duties as assigned.
• Assists floor(s) with transportation barriers during working hours.

Benefits

• Comprehensive benefits: multiple levels of medical, dental and vision coverage for full‑time and part‑time employees.
• Financial protection & paid time off: life, accident, critical illness, hospital indemnity insurance, short‑ and long‑term disability, paid family leave, and paid time off.
• Career growth: higher education and certification tuition assistance, loan assistance, 401(k) retirement package and company match.
• Employee well‑being: mental, physical and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional development: ongoing learning and career advancement opportunities.

Qualifications

• Current state RN license.
• Associate or bachelor’s degree from an accredited nursing school.
• BLS certification.
• Minimum 3 years of acute‑care experience as a professional nurse or RN with significant acute‑care hospital case management experience.
• Previous case management experience preferred.
• Case‑management certification (CP preferred).

EEOC Statement

Conemaugh Memorial Medical Center is an Equal Opportunity Employer. Conemaugh Memorial Medical Center is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.