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Job description
Description
nnnPROFESSIONAL ROLE
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nnMaintains professional and technical knowledge by attending education workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
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nnAssures quality of care by adhering to therapeutic standards; measuring health outcomes against patient care goals and standards; making or recommending necessary adjustments; following system/hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations.
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nnProtects patients and employees by adhering to infection-control policies and protocols.
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nnDocuments patient status recommendations, care coordination, and discharge planning by charting in patient records.
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nnMaintains continuity among the multidisciplinary team by documenting and communicating actions, irregularities, and continuing needs.
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nnMaintains patient confidence and protects operations by keeping information confidential.
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nnEnsures safe and effective transitions of care through standard work that help to promote positive health care outcomes for Excela Health patients.
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nnCLINICAL ROLE
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nnAssesses, plans, implements coordinates, and monitors and evaluates options for patients, their families, caregivers and the health care team, including providers, to promote effective care coordination outcomes.
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nnManages transitions of care effectively as one of the critical components to reducing readmissions and poor health outcomes. Provides crisis management for clients; makes linkages for interventions as appropriate.
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nnInitiates care coordination strategies that are evidence-based and outcome focused.
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nnIdentifies patient care requirements by establishing personal rapport with patients, and care givers that need to understand care requirements.
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nnEstablishes a compassionate environment by providing emotional, psychological, and spiritual support to patients, friends, and families.
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nnPromotes patient's independence by establishing patient care goals; teaching patient/family to understand condition, medications, and self-care skills; answering questions.
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nnMaintains safe and clean working environment by complying with procedures, rules and regulations; calling for assistance from health care support personnel.
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nnDemonstrates competencies of clinical reasoning and critical-thinking skills for managing complex and high-risk patients while simultaneously assuming the patient advocate role to ensure conflict-free, unbiased and culturally competent care.
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nnAssures care coordination that takes into account patients' values, needs, preferences and their choice to self-direct care.
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nnLEADERSHIP ROLE
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nnPuts the patient at the center of all care decisions and is an essential driver to ensuring that patients get the right care, in the right setting, at the right time.
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nnEffectively manages transitions involving comprehensive planning, targeted outreach and the timely transfer of information between parties critical to the transition. Manages transitions of care effectively as one of the critical components to reducing re-admissions and poor health outcomes.
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nnFacilitates the flow of care to expedite appropriate discharge and prevent readmissions.
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nnAssumes the leadership role in achieving outcomes and making the health system work for the patient.
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nnBrings access, understanding and knowledge of the community and the resources to support management of chronic illness.
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nnResolves patient problems and needs by utilizing multidisciplinary team strategies.
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nnMaintains a cooperative relationship among health care teams by communicating information; responding to requests; building rapport; participating in team continuous quality improvement and problem-solving methods.
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nnContributes to team effort by accomplishing related results as needed.
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nnImplements effective care coordination strategies that are evidence-based and outcome focused.
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nnOther duties as assigned.
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n nSpecialty Essential Functions
nnnLevel of Care Management
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nnReviews clinical criteria of all ED / Direct Admission patients for appropriate patient status (i.e. inpatient, observation services, outpatient testing/treatment) based on medical necessity criteria.
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nnDiscusses recommendations for level of care with ED physician and attending physician.
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nnDiscusses options for care with patients, families, and physicians involved in their care.
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nnRemotely monitors bed board (where applicable).
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nnPsychosocial
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nnAssists patients and their families through the complex emergency room environment and/or the hospitalization process.
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nnProvides emotional support to patients and their families/support system as needed.
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nnConnects patients and their families/support system to community services as needed and appropriate.
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nnDischarge Planning / Case Management
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nnPlans, coordinates, and implements discharge plans for ED and ED hold patients, including but not limited to, referrals to skilled nursing facilities, personal care homes, home health, DME, drug and alcohol treatment facilities, transportation, or community-based services.
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nnCoordinates authorization for admitted patients and/or patients transferred from the ED.
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nnProvides case management follow through for the Unit Based Case Manager on cases requiring follow-through after normal business hours.
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nnProfessional Development
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nnAttend meetings as appropriate and meet regularly with supervisor to exchange pertinent information.
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nnParticipates in continuing education activities, remaining knowledgeable in area(s) or expertise.
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nnMaintains a high level of ethical conduct regarding confidentiality, dual-relationships and professional stature.
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nnMaintains patient and program records in accordance with applicable standards and regulations, grant requirement, etc.
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nnUtilization
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nnApplies InterQual level of care criteria for Severity of Illness/Intensity of Service Indicators for potential admissions and ED hold patients. Makes referral to Physician Advisor for second level review for patients in the ED hold not meeting inpatient criteria.
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nnRecognizes and progresses the plan of care when an alternative level of care is appropriate.
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nnCollaborates with the attending physician and multidisciplinary healthcare team to facilitate the progression of the plan of care.
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nnCognizant of payor requirements for all patients in assigned caseload. Responsible for understanding and communicating plan benefit limits/availability to patient or their representative in management of case as necessary.
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nnResponsible for accurate and timely documentation in recognized databases to support Clinical Resource Management and ED components for each patient in assigned caseload.
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nnDenial Management
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nnInitiates contact with the attending physician on cases that do not meet InterQual Level of Care SI/IS indicators in order to clarify plan of care.
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nnEducates physicians and other members of the healthcare team on the application of InterQual Level of Care Criteria to support an acute level of care and provides alternatives to acute care as appropriate.
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nnNotifies the unit-based case manager of all real or potential cases in which an adverse determination or complex psychosocial situation is anticipated.
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nnIdentifies and facilitates transition to the most appropriate alternate level of care.
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n nRequired Qualifications
nnnGraduated of an accredited nursing program.
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nnTwo (2) years recent healthcare/clinical experience, or recent clinical experience in an emergency department, case management, or utilization review position.
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nnStrong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of nursing practice.
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nnStrong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.
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nnKnowledge of payor/insurance benefits
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nnFunctional Skills on PC and Related Software (Microsoft Office)
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nnKnowledge of basic office equipment such as copier, fax machine, etc.
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nnAbility to understand and react effectively in a fast-paced environment. Must have flexibility/prioritization skills.
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n nPreferred Qualifications
nnnBSN
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nnCase management experience
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nnCase management certification
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n nLicense, Certification & Clearances
nnnCurrent licensure to practice as a Registered Nurse in the State of Pennsylvania
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nnAct 33 with renewal
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nnAct 34 with renewal
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nnAct 73 FBI Clearance
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n nSupervisory Responsibilities
nnThis position has no direct supervisory responsibilities, but does serve as a coach and mentor for other positions in the department.
n nPosition Type/Expected Hours of Work
nnnIncumbent will be scheduled based on operational need (rotating shifts, weekend rotation).
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nnTravel may be expected locally between Independence Health locations.
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n nWork Environment
nEffective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines
nWhen lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.
nEssential – Absolute Necessity.
nMarginal – Minimal Necessity.
nConstantly – 5.5 to 8 hours or more or 200 reps/shift.
nFrequently – 2.5 to 5.5 hours or more or 32-200 reps/shift.
nOccasionally – 0.25 to 2.5 hours or 2-32 reps/shift.
nRarely – Less than 0.25 hours or less than 2 reps/shift.
nPhysical Condition
nEssential
nMarginal
nConstantly
nFrequently
nOccasionally
nRarely
nNever
nExtreme Heat
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nExtreme Cold
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nHeights
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nConfined Spaces
nX
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nExtreme Noise(>85dB)
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nMechanical Hazards
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nUse of Vibrating Tools
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nOperates Vehicle (company)
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nOperates Heavy Equipment
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nUse of Lifting/Transfer Devices
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nRotates All Shifts
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n8 Hours Shifts
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n10-12 Hours Shifts
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nOn-Call
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nOvertime(+8/hrs/shift; 40/hr/wk)
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nTravel Between Sites
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nDirect Patient Care
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nRespirator Protective Equipment
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nEye Protection
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nHead Protection (hard hat)
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nHearing Protection
nX
nHand Protection
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nFeet, Toe Protection
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nBody Protection
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nLatex Exposure
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nSolvent Exposure
nX
nPaint (direct use) Exposure
nX
nDust (sanding) Exposure
nX
nEthylene Oxide Exposure
nX
nCytotoxic (Chemo) Exposure
nX
nBlood/Body Fluid Exposure
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nChemicals (direct use) Exposure
nX
nMist Exposure
nX
nWax Stripper (direct use)
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nNon-Ionizing Radiation Exposure
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nIonizing Radiation Exposure
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nLaser Exposure
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nPhysical Demands
nWhen lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.
nEssential – Absolute Necessity.
nMarginal – Minimal Necessity.
nConstantly – 5.5 to 8 hours or more or 200 reps/shift.
nFrequently – 2.5 to 5.5 hours or more or 32-200 reps/shift.
nOccasionally – 0.25 to 2.5 hours or 2-32 reps/shift.
nRarely – Less than 0.25 hours or less than 2 reps/shift.
nPhysical Condition
nEssential
nMarginal
nConstantly
nFrequently
nOccasionally
nRarely
nNever
nBending (Stooping)
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nSitting
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nWalking
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nClimbing Stairs
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nClimbing Ladders
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nStanding
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nKneeling
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nSquatting (Crouching)
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nTwisting/Turning
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nKeyboard/Computer Operation
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nGross Grasp
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nFine Finger Manipulation
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nHand/Arm Coordination
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nPushing/Pulling(25lbs.of force)
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nCarry
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nTransfer/Push/Pull Patients
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nSeeing Near w/Acuity
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nFeeling (Sensation)
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nColor Vision
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nHearing Clearly
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nPulling/Pushing Objects Overhead
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nReaching Above Shoulder Level
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nReaching Forward
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nLifting Floor to Knuckle
nn10-19
n20>50
nLifting Seat Pan to Knuckle
nn10>50
nLifting Knuckle to Shoulder
nn10>50
nLifting Shoulder to Overhead
nn10>50
nWhen lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.
nEqual Opportunity Employer/Protected Veterans/Individuals with Disabilities
nThis employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights ( notice from the Department of Labor.
Worksite address
greensburg, PA, 15605, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.