Case Manager RN (Full Time), St. Vincent

Company :

Job Description :

St. Vincent Hospital

St. Vincent Hospital is a Magnet-designated hospital for excellence in nursing serving the people in the Lake Erie region since 1875 with a quality of care and service second to none!

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

• Bachelors Degree in Nursing -OR- Bachelors 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 12/31/2025 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

• 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)

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 Companys Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore it is every employees responsibility to comply with the companys 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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