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

An established industry player is seeking a dedicated Case Manager to join their team. In this vital role, you will oversee the coordination of clinical care, ensuring that patients receive personalized support throughout their healthcare journey. You will collaborate with a multidisciplinary team to create effective discharge plans and communicate essential information to patients and families. This full-time position offers a unique opportunity to make a meaningful impact in the lives of patients while advancing your professional growth in a supportive environment. If you are passionate about patient care and thrive in a dynamic setting, this role is perfect for you.

Qualifications

• Bachelor’s Degree in Nursing or equivalent experience required.
• 3 years in a clinical nursing role with current RN licensure.

Responsibilities

• Coordinate clinical care with patients and interdisciplinary teams.
• Document admission, concurrent, and discharge reviews for patients.
• Develop and implement effective discharge plans.

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

Optical Character Recognition (OCR)

Job description

Company :

Allegheny Health Network

Job Description :

REPOSTED: 20241206

REPOSTED: 20241122

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, 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.

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.