Registered Nurse (RN) Case Manager
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Job Location:
Johnstown, PA - USA
Monthly Salary:
Not Disclosed
Posted on:
15 days ago
Vacancies:
1 Vacancy
Job Summary
Registered Nurse (RN) - Case Manager
Job Type: Full Time M-F 730-400 or 8-430 rotating weekends on call
Your experience matters
More about our team
The Utilization Management RN Case Manager (UM-RNCM) functions under the direction of the Case Management Manager. The UM-RNCM performs initial clinical documentation reviews on assigned patients to substantiate Severity of Illness and Intensity of Service based on Industry Standard Criteria. The UM-RNCM refers cases not meeting MCG Criteria to the physician advisors and follows through on cases to assure regulatory compliance.Clinical information is relayed to the managed care companies to obtain authorizations for payment. The UM-RNCM is responsibility for correct status within the hospital and communication with physicians if a case is denied.
How youll contribute
ARegistered Nurse (RN) Case Managerwho excels in this role:
Skilled in Case Management functions and Care Coordination
Utilizes Interqual or the 2MN rule to determine status for all patients assigned an acute care bed.
Reviews medical records and provides accurate clinical information to payers for authorization.
Collaborate with interdisciplinary team to facilitate progression of care and resource utilization.
Proactively interacts with patients and families during the admission process to set expectations for the course of stay and length of stay.
Proactively analyzes information from the care team to support inpatient admission.
Assesses identifies and intervenes to reduce the risk of barriers that will interfere with the transition of care.
Facilitates optimal care transition to reduce avoidable readmissions.
Follows the Case Management policy & procedure for utilizing Physician Advisors.
Interacts with attending physicians physician advisor and department chairs about any identified quality issues and utilization issues.
Leads Interdisciplinary Discharge Planning Rounds (IDTs) to determine appropriate concurrent care planning resource utilization and appropriate post acute level of care determination.
Identifies and documents avoidable days and intervenes promptly to remove identified barriers.
Follows CMS & regulatory requirements for Case Management processes.
Coordinates concurrent denial/appeal- (peer to peer) process for assigned cases.
Assumes on-call and weekend duties as assigned.
Assist floor(s) with transportation barriers during working hours.
Why join us
We believe that investing in our employees is the first step to providing excellent patient addition to your base compensation this position also offers:
Comprehensive Benefits:Multiple levels of medical dental and vision coverage withmedical plans starting at just $10 per pay period tailored benefit options for part-time and PRN employees and more.
Financial Protection & PTO:Life accident critical illness hospital indemnity insurance short- and long-term disability paid family leave and paid time off.
Financial & Career Growth:Higher education and certification tuition assistance loan assistance and 401(k) retirement package and company match.
Employee Well-being:Mental physical and financial wellness programs (free gym memberships virtual care appointments mental health services and discount programs).
Professional Development:Ongoing learning and career advancement opportunities.
What were looking for
Applicants should have a current state RN license and possess an associate or bachelors degree from an accredited nursing school. Additional requirements include:
BLS Certification
3 years experience in acute care as a Professional Nurse or RN experience with significant acute care hospital Case Management experience
Previous case management experience preferred
Case management certification CP preferred
More about Conemaugh Memorial Medical Center
Conemaugh Memorial Medical Center is a 537-bed behavioral health rehabilitation and transitional care hospitalthat has been offering exceptional care to the Johnstown community for over 135 years. We are proud to be recognized by the American Heart Association with the Stroke Gold Plus Quality Achievement Award.
EEOC Statement
Conemaugh Memorial Medical Center is an Equal Opportunity Employer.Conemaugh Memorial Medical Centeris committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
Required Experience:
Manager
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Hospice Care
- Workers' Compensation Law
- Home Care
- Nursing
- Catheterization
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 a ... View more
