RN Case Manager (Part Time) - Forbes Hospital

IntelliResume; Monroeville (Allegheny County); On-site; USD 45,000 - 65,000; Part time

Job summary

Highmark Health is seeking a part-time RN Case Manager for Forbes Hospital in Monroeville, PA to coordinate patient care and transitions in accordance with established standards. The role requires a Bachelor’s degree in nursing and at least 3 years of clinical nursing experience, with PA RN licensure or multi-state licensure (eNLC) preferred.

You will assess needs, develop care transition plans, document data, obtain pre-certifications, and support utilization review while upholding

Qualifications

• Bachelor's Degree in Nursing required, 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 required.
• Current State of PA RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) required.
• Preferred: Nationally recognized Case Management Certification.

Responsibilities

• Assess patient physical, psychosocial, and economic needs for effective transition of care planning.
• Collaborate with the care team to develop and communicate the continuum of care transition plan.
• Document, verify, and validate specific data to monitor and evaluate interventions and outcomes.
• Interview and collect patient-specific data and conduct chart reviews related to readmission.
• Ensure compliance with accreditation and regulatory requirements.
• Integrate performance improvement and customer service principles into job responsibilities.
• Obtain pre-certification authorizations from third-party payers prior to hospitalization.
• Facilitate acquisitions of urgent/emergent authorizations and continued stay authorizations.
• Document, monitor, and report clinical denials/appeals and retrospective payer audit denials.
• Serve as an educational resource regarding utilization review practices and payer guidelines.

Education

Bachelor's Degree in Nursing

Job description

About This Role

The RN Case Manager at Highmark Health is responsible for coordinating patient care and managing transitions in accordance with established standards. This part-time role is ideal for a registered nurse with expertise in care management and a commitment to patient satisfaction.

Highlights

• Location: Monroeville, PA
• Facility: Forbes Hospital
• Schedule: Part-time

What You'll Do

• Assess patient physical, psychosocial, and economic needs for effective transition of care planning.
• Collaborate with the care team to develop and communicate the continuum of care transition plan.
• Document, verify, and validate specific data to monitor and evaluate interventions and outcomes.
• Interview and collect patient-specific data and conduct chart reviews related to readmission.
• Ensure compliance with accreditation and regulatory requirements.
• Integrate performance improvement and customer service principles into job responsibilities.
• Obtain pre-certification authorizations from third-party payers prior to hospitalization.
• Facilitate acquisitions of urgent/emergent authorizations and continued stay authorizations.
• Document, monitor, and report clinical denials/appeals and retrospective payer audit denials.
• Serve as an educational resource regarding utilization review practices and payer guidelines.

Requirements

Education:

• Bachelor's Degree in Nursing required, or Bachelor's Degree and Nursing Diploma, or 6 years of relevant experience in lieu of a degree.

Experience:

• 3 years in a clinical nursing role required.

Licenses & Certifications:

• Current State of PA RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) required.
• Preferred: Nationally recognized Case Management Certification.

About Highmark Health

Highmark Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on innovative solutions to improve health outcomes and enhance the patient experience.