RN Acute Case Manager - System Care Management - PD

Guthrie; Troy (Bradford County); On-site; USD 80,000 - 110,000; Full time

Job summary

Guthrie is seeking an RN Acute Case Manager at Troy Community Hospital in Troy, PA. The role focuses on coordinating medical management and utilization across the continuum of care to achieve quality outcomes.

Ideal candidates have a BSN/BA with at least five years in acute care, leadership experience, and a willingness to pursue BSN within two years. On-site duties support hospital-based care coordination.

Qualifications

• RN with BSN or BA in Nursing; BSN required within two years of hire.
• Five (5) years of relevant experience in nursing with leadership capability.
• Case management certification encouraged but not required.

Responsibilities

• Collaborate with healthcare team to ensure appropriate medical management and resource utilization.
• Educate physicians and health care team on care processes across the continuum.
• Participate in on-call system to ensure 24-hour availability and accountability.
• Serve as patient advocate representing the patient’s best interests to providers.
• Procure insurance authorizations to ensure cost-effective care and appropriate utilization.
• Lead coordination of care from admission through discharge and transition to outpatient services.

Skills

Care coordination

Clinical leadership

Critical thinking

Communication

Education

BSN in Nursing

BA in Nursing (optional)

Job description

RN Acute Case Manager - System Care Management - PD

Shift: Variable hours during Monday-Friday 8:00am-4:30pm.

This position is onsite at Troy Community Hospital in Troy, PA.

Position Summary:

The Acute Case Manager utilizes industry accepted processes for achieving optimal patient, clinical, and operational outcomes timely, coordinated, and in cost effective manners. The Acute Case Manager has the responsibility, accountability, and authority for coordinating the medical management of hospital patients, using outcomes-based approaches. The Acute Case Manager supports the healthcare team in assessing, planning, and facilitating individualized continuum of care plan for patients, based on assessed needs and available resources. The Acute Case Manager monitors clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal and external offices, payors, and providers. The Acute Case Manager collaborates cooperatively with the patient and members of the interdisciplinary health care team. The Acute Case Manager takes a proactive approach to ensuring the integration of both clinical and operational outcomes through analysis of clinical and financial data, including length of stay and DRG profiling.

Education, License & Cert:

RN Bachelor of Science degree in Nursing (BSN) or, a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or BA degree will be considered. Must obtain BSN within two (2) years of hire. Individual consideration may be given to a registered nurse, with significant clinical experience, who holds a bachelor’s degree in a related field.

Experience:

BSN or BA with a minimum of five (5) years relevant experience who demonstrates leadership and autonomy in nursing practice. a) Utilize critical thinking skills to create and or develop a clinical program or position and b) Demonstrated leadership skills for a licensed degree exception, there must be a significant depth of clinical experience: five (5) years of experience in an acute care setting with strong care management, utilization review, and payer knowledge. A Case Management certification or obtaining a Case Management certification within one (1) year of eligibility is encouraged.

Essential Functions:

1. The Acute Case Manager collaborates to support that the right care is provided to patients in the right setting with a broad spectrum of health and community providers.
   • Works closely with the Medical Director and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria.
   • Educates the physician and other healthcare team members regarding the coordination of care processes of the patient across the continuum of care.
   • Entity specific acute case manager may need to participate in an on‑call system to ensure 24‑hour accessibility and accountability to meet patient needs.
   • Serves as patient advocate in representing the patient’s best interests to the providers.
   • Procures insurance authorizations where indicated to ensure appropriate, cost effective care.
   • Acts as an institutional advocate by managing care in a cost-effective manner and communicating with third party payers.
2. Coordinates medical management through ongoing interaction with the patient and family/caregivers, physician and other health care providers to achieve designated clinical, operational and financial outcomes.
   • Facilitates clinically appropriate treatment and coordinates flow of services by acting as a focal point for communication for healthcare team members, patient, provider, and payer.
   • Supports development, integration, and monitoring.
   • Maintains accountability for coordination of care processes for the patient during the acute care phase, and during the transition phase to outpatient services.
   • Initiates and participates in patient care conferences as appropriate.
   • Completes nursing assessment forms in the system.
   • Addresses PRI and other referral procedures as needed for continuing care needs.
   • Provides leadership for clinical staff regarding complex patient care concerns and/or care of patients who do not achieve expected outcomes.
3. Identifies individual patient discharge needs in collaboration with other clinical team members beginning upon initial admission assessment and continued reassessment throughout an episode of care. Takes the initiative in working with the interdisciplinary health care team and patient/family to identify a treatment regime which streamlines care, reduces or controls costs and enhances patient outcomes.
   • Assists in the implementation of discharge planning as necessary, through concurrent monitoring and reevaluation, to accommodate changes in treatment or progress. Antici