RN Case Manager (Days) Jefferson

highmarkhealth; Jefferson Hills (Allegheny County); On-site; USD 75,000 - 110,000; Full time

Job summary

Allegheny Health Network is seeking a qualified Nurse Case Manager to develop and evaluate care plans for patients and families. You will collaborate with clinicians, health plans, and external partners to optimize outcomes and resource use.

The role emphasizes readmission reduction, length of stay optimization, and patient satisfaction through advocacy, education, and coordinated care delivery.

Qualifications

• Bachelor's Degree in Nursing required or equivalent (Nursing Diploma with experience).
• Current PA RN licensure or multi-state licensure via eNLC.
• Minimum 3 years in a clinical nursing role.
• Strong critical thinking and problem-solving abilities.
• Excellent communication and collaboration with diverse teams.

Responsibilities

• Contributes to comprehensive assessments of patients and families.
• Identifies barriers and analyzes risk for admission/readmission.
• Coordinates clinical care with patient, family, and interdisciplinary team.
• Advocates for patients by communicating with providers, payers, and post-acute partners.
• Educates patients and families on care needs, utilization, and transitions.
• Pursues professional development and adheres to hospital policies.

Skills

Critical thinking

Problem solving

Communication skills

Collaboration

Flexibility/adaptability

Education

Bachelor's Degree in Nursing

Bachelor's Degree + Nursing Diploma

6 years of experience in lieu of a degree

Job description

Company : Allegheny Health Network Job Description :

General Overview

This job has responsibility for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum. Incumbents will utilize nationally recognized standards of practice for case management by collaborating with providers, clinical teams, health plans, and external partners while advocating for patients and caregivers in order to align goals and plans. Incumbents will serve as professional role models, utilizing their expertise in care management to promote a collaborative professional environment that optimizes outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization. Serves as key team members in the management of readmissions, length of stay, ED utilization, and patient/family satisfaction.

Essential Responsibilities

• Contributes to or completes comprehensive assessment of patients and their families/caregivers, inclusive of clinical/physical needs, social determinants of health, and economic barriers impacting their ability to manage their health. (20%)
• Effectively identifies barriers and analyzes situations for assigned patient population, including risk for admission/readmission, external resources, and patient/family capacity in order to determine safe plans for transition and care coordination. (20%)
• Coordinates the clinical care with the patient, family, provider(s), and members of the interdisciplinary team. (25%)
• Advocates for patients and families through effectively communicating with providers, interdisciplinary team members, payers, and post-acute partners to assure effective outcomes and care. (15%)
• Leverage understanding of industry standards to provide applicable education to patients, families, providers, and interdisciplinary team partners including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%)
• Actively seeks professional development opportunities through professional certification, mentoring/precepting, and/or participation on department/hospital/system committees. (5%)
• Adheres to the policies, procedures, rules, regulations, and requirements of hospitals and other clinical settings. (5%)

Qualifications

Minimum

• Bachelor's Degree in Nursing -OR- Bachelor's Degree and Nursing Diploma -OR- 6 years of relevant experience in lieu of a degree
• 3 years in a clinical nursing role
• Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Critical thinking and problem solving
• Flexibility and adaptability to change
• Strong communication and collaboration skills with ability to tailor style according to target audience (providers, peers, clinical team members, patients, families)

Preferred

• Nationally recognized Case Management Certification
• Transition planning and understanding of community and facility resources
• Knowledge of motivational interviewing techniques
• BSN

Licenses or Certifications

Required

• None

Preferred

• ACM Certification (Accredited Case Manager) - American Case Management Association - American Case Management Association
• Case Management - American Board of Occupational Health Nurses (ABOHN) and
• Certified Case Manager (CCM)
• Commission for Case Manager Certification (CCMC)

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
• Professional Certification within 5 years of start date. Incumbents in role as of 12/1/2022 have until 12/31/2026 to obtain

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