Registered Nurse (RN) - Case Manager

Conemaugh Memorial Medical Center; Johnstown (Cambria County); On-site; USD 65,000 - 85,000; Part time

Benefits offered by this job

Multiple levels of medical, dental and vision coverage

Tuition assistance and loan assistance

Employee wellness programs

Job summary

Conemaugh Memorial Medical Center is seeking a Registered Nurse (RN) - Case Manager in Johnstown, PA. This critical role involves managing clinical documentation and regulatory compliance for patients, ensuring appropriate care transitions and utilization.

The ideal candidate will hold a current state RN license, have significant acute care experience, and possess strong skills in case management. The position offers a range of comprehensive benefits including medical, dental, and career growth programs.

Qualifications

• 3 years experience in acute care as a professional nurse or RN.
• Significant acute care hospital Case Management experience.
• Previous case management experience preferred.

Responsibilities

• Validate Severity of Illness using industry-standard criteria.
• Communicate clinical information to managed care organizations.
• Lead Interdisciplinary Discharge Planning Rounds.

Skills

Case Management functions

Care Coordination

Interqual system

Clinical documentation

Collaboration with interdisciplinary team

Education

Associate or bachelor's degree from an accredited nursing school

Current state RN license

BLS Certification

Job description

Registered Nurse (RN) - Case Manager

Job Type: PRN | M-Sun 8a-430p

Role Overview

This 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. This role is responsible for communicating clinical information to managed care organizations to secure authorization for services and reimbursement. The UM-RNCM also ensures accurate patient status throughout the hospital stay and collaborates closely with physicians to address and resolve any denial determinations.

Key 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 advisor and department chairs about any identified quality issues and utilization issues
• Leads Interdisciplinary Discharge Planning Rounds (IDTs) to determine appropriate concurrent care planning, resource utilization and appropriate post-acute level of care determination
• Identifies and documents avoidable days and intervenes promptly to remove identified barriers
• Follows CMS & 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 & PTO: life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off
• Financial & career growth: higher education and certification tuition assistance, loan assistance and 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
• 3 years experience in acute care as a professional nurse or RN
• 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.