RN Care Coordinator, AVH, Full Time

Highmark Health; Natrona Heights (PA); On-site; USD 70,000 - 90,000; Full time

Job summary

Allegheny Health Network is seeking an experienced Registered Nurse to coordinate patient progress toward quality and cost outcomes. You will mobilize resources and manage the system to meet established standards in a dynamic healthcare setting.

Responsibilities include utilization management, collaboration with physicians and multidisciplinary teams, and implementing effective discharge plans to ensure safe transitions and optimal patient outcomes.

Qualifications

• 5 years acute Medical/Surgical nursing experience.
• BA/BS degree and Nursing school diploma required.
• Preferred experience in utilization management and/or working for a third-party payor/review agency.

Responsibilities

• Responsible for utilization management.
• Collaborates with physicians and multidisciplinary teams to ensure efficient resource use and attainment of patient goals.
• Implements an effective discharge plan.

Education

RN licensure PA or multi-state eNLC

BSN / BSc Nursing degree

Job description

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW Coordinates patient progress toward achieving quality and cost outcomes; mobilizes resources and manages the system in response to concurrent variances according to the pre-established standards.

ESSENTIAL RESPONSIBILITIES

• Responsible for utilization management. (50%)
• Communicates and collaborates with physicians and multidisciplinary teams to ensure appropriate management of resources to attain patients individualized goals in an appropriate and timely manner and appropriate setting. (30%)
• Implements an effective discharge plan. (20%)

QUALIFICATIONS

• Minimum Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• 5 years acute Medical/Surgical and/or specialty care nursing required.
• BA/BS degree and Nursing school diploma required
• Preferred Experience in utilization management and/or employment by a third party payor/review agency preferred.

Additional Employment Requirements:

• CPR – American Heart Association
• Act 34 Criminal Background Clearance Certificate
• Act 33 Child Abuse Clearance Certificate
• Act 73 FBI Fingerprinting Criminal Background Clearance Certificate

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.