RN Case Manager (Full Time 40 Hours), West Penn Hospital

Highmark Health; Pittsburgh (Allegheny County); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Free parking

Magnet recognition

Job summary

Allegheny Health Network, part of Highmark Health, seeks an on-site RN Case Manager for West Penn Hospital in the Bloomfield area of Pittsburgh, PA. The role requires Monday–Friday on-site presence 8am–4:30pm, with responsibilities across care coordination and patient/family advocacy.

Minimum qualifications include a Bachelor's in Nursing (or Nursing Diploma with 6 years of relevant experience) and PA RN licensure.

Qualifications

• Bachelor’s Degree in Nursing or Nursing Diploma with 6 years of experience in lieu of a degree.
• Current RN licensure in PA or multi-state licensure under eNLC.
• Professional certification within 5 years of start date is preferred.

Responsibilities

• Contribute to or complete comprehensive assessment of patients and families, including social determinants and barriers.
• Identify barriers and analyze situations to determine safe transition plans and care coordination.
• Coordinate clinical care with patient, family, providers, and interdisciplinary team.
• Advocate for patients and families through effective communication with providers, payers, and post-acute partners.
• Educate patients and families on care, documentation, insurance benefits and transition planning requirements.
• Pursue professional development through certification, mentoring, or department committees.
• Adhere to hospital policies and HIPAA/privacy requirements.

Skills

Critical thinking

Communication

Collaboration

Flexibility

Education

Bachelor’s Degree in Nursing

Nursing Diploma

6 years of relevant experience in lieu of degree

Job description

Company :

Allegheny Health Network

Job Description :

This role is an on-site role at AHN West Penn Hospital located in the Bloomfield neighborhood of Pittsburgh, PA. On site requirements are Monday-Friday 8am-4:30pm.

WEST PENN HOSPITAL:

West Penn Hospital has four-time Magnet® recognition, private patient rooms, free employee parking and a generous benefit package (for full-time and part‑time status employees). They are nationally recognized for their burn care, and the only pediatric burn center in western Pennsylvania to be verified by the American Burn Association and the American College of Surgeons. They are also ranked in the nation’s top‑50 hospitals for OB‑GYN care by the US News and World Report.

ALLEGHENY HEALTH NETWORK:

At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities. AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees.

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).
• Professional Certification within 5 years of start date. Incumbents in role as of 12/1/2022 have until 12/31/2026 to obtain
• 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)
• CPR – American Heart Association
• Act 34 Criminal Background Clearance Certificate
• Act 33 Child Abuse Clearance Certificate
• Act 73 FBI Fingerprinting Criminal Background Clearance Certificate

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)

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_ 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.

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