RN Case Manager Emergency Department/CDU (Nights), Allegheny General Hospital

Highmark Health; Oregon (IL); On-site; USD 80,000 - 100,000; Full time

Job summary

Join a forward-thinking healthcare organization as an RN Case Manager in the Emergency Department! This full-time position offers the opportunity to make a significant impact on patient care by coordinating clinical services and developing individualized discharge plans. With a focus on quality and cost-effectiveness, you'll work collaboratively with patients, families, and healthcare professionals to ensure optimal outcomes. If you're a compassionate and skilled nurse looking to advance your career in a supportive environment, this role is perfect for you. Embrace the chance to grow professionally while providing essential care to those in need.

Qualifications

• Bachelor’s in Nursing or 6 years relevant experience required.
• 3 years in a clinical nursing role and current RN licensure needed.

Responsibilities

• Coordinate clinical care with patients and interdisciplinary teams.
• Complete admission and discharge reviews for inpatients and outpatients.
• Develop effective discharge plans with input from all stakeholders.

Skills

Critical thinking

Problem solving

Communication skills

Collaboration skills

Flexibility

Adaptability

Education

Bachelor’s Degree in Nursing

Nursing Diploma

6 years of relevant experience

Tools

CPR certification

Case Management Certification

Job description

Thank you for your interest in employment at a Highmark Health company. Highmark Health uses an online application process. If you participate in the online application process through this Workday site, your personal information will be collected, including but not limited to data such as your resume and resume content, education, contact information, address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide.

RN Case Manager Emergency Department/CDU (Nights), Allegheny General Hospital

Company : Allegheny Health Network

Job Description :

Date Posted: 20240228

Location: Allegheny General Hospital

Department: Case Management, Emergency Department/CDU

Status: Full Time

Shift: 80 hours every two weeks

Steady Nights, 40 hours per week, 11p-7a or 7p-7a, rotating weekends and holidays

Union: Yes

CASE MANAGEMENT:

The Case Management Department at Allegheny General Hospital assists patients and their support systems in managing medical conditions effectively. Our team of talented Case Managers aims to individualize health care to meet each patient's specific needs with a patient-centric and outcome-driven focus.

GENERAL OVERVIEW

This job oversees, develops, and manages the end-to-end claims functions and operational inputs including but not limited to the receipt of claims, operational correspondences, and corporate correspondences for multiple customer segments; fully utilizes the support mechanisms available to complete the required delivery of high-performance, efficient, and low-cost production. Responsible for mail services, imaging, and Optical Character Recognition (OCR) including vendor relations and communicating with operational areas regarding issues related to supported technology. Manage utilization review, translation of foreign claims, coordination of benefits (COB), and processing of claims with unique processing arrangements including Federal Employee Program (FEP) and Medicare Advantage.

ESSENTIAL RESPONSIBILITIES

• Coordinates the clinical care with the patient, family, physician(s), and other members of the interdisciplinary team.
• Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients.
• Develops and implements an effective discharge plan while incorporating input from the patient, family, physician(s), and other members of the interdisciplinary team.
• Identifies, analyzes, collects, and communicates data relative to quality and cost issues related to the assigned patient population.
• Expands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues.
• Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies.

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).
• CPR certification
• Nationally recognized Case Management Certification within 5 years of start date.
• 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)

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.

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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.