About this opportunity
Excela Health lists this CASE MANAGER - RN opportunity in mt pleasant, Pennsylvania. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Description
nnnMaintains 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, medication administration and storage procedures, and controlled substance regulations.
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nnDocuments patient care services by charting in patient and department records.
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nnMaintains continuity among nursing teams by documenting and communicating actions, irregularities, and continuing needs using Nurse Knowledge Exchange techniques.
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nnMaintains patient confidence and protects operations by keeping information confidential.
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nnImplements standard work, clinical protocols and patient care pathways.
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nnEnsures safe and effective transitions of care that help to promote positive health care outcomes for Independence Health System patients.
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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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nnImplements standard work, clinical protocols and patient care pathways.
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nnIdentifies patient care requirements by establishing personal rapport with potential and actual patients, and other persons in a position 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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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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nnEnsures operation of equipment by completing preventive maintenance requirements; following manufacturer's instructions; troubleshooting malfunctions; calling for repairs; maintaining equipment inventories; evaluating new equipment and techniques.
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nnOther duties as assigned.
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n nSpecialty Essential Functions
nnnDischarge Planning
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nnAssesses, plans, implements, coordinates, 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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nnCoordinates alternate levels of care based on the patient's current needs and availability of healthcare resources.
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nnCreatively resolves complicated disposition issues, utilizing community resources with the integration of the patient's available benefits to achieve a positive outcome.
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nnProvides information for appropriate referrals to patients and their families, and provides counseling, if needed, on a limited basis.
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nnMaintains patient rights by adhering to HIPAA, Freedom of Choice, Rights of Reconsideration, QIO, and other regulatory agency requirements.
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nnFacilitates the flow of care to expedite appropriate discharge and prevent readmission.
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nnInvolves patients and families in goal setting and evaluation health care system.
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nnEnsures safe and effective transitions of care across settings for patients.
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nnCase Manager works in collaboration with the Denial Management Specialist:
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nnFacilitates appeals/grievances for concurrent and retrospective appeals.
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nnAssists with maintaining databases that reflect the appeal/grievance component of the utilization process.
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nnConsults with Denial Management Specialist, department Manager and Physician Advisor or designee to resolve issues regarding adverse determinations and denials.
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nnAssists the Denial Management Specialist in designated facets for the appeal/grievance process, including medical record review for medical necessity, conferring with Physician Advisor or designee, formulating correspondence, and maintaining accurate files.
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nnProvides timely correspondence to meet requirements of all payors, as it relates to the appeal process.
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nnCollaborates with Patient Accounting Department and other ancillary departments for resolution of payor reimbursement issues in a timely manner.
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nnResponsible for data collection related to status of denials/delays.
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nnCase Manager works in collaboration with Utilization Review
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nnCompletes initial utilization review for medical necessity for an assigned patient population.
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nnInitiates assessment within 24 hours of admission or next business day.
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nnApplies Intergual criteria for severity of illness/intensity of service indicators. Makes referral to PA/VPMA or designee for second level review in cases not meeting initial medical necessity criteria screens.
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nnRecognizes and progresses the plan of care when an alternative level of care is appropriate.
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nnConducts continued stay reviews by monitoring patient’s response to treatment and resource utilization.
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nnCollaborates with Attending Physician and healthcare team to facilitate the progression of the plan of care.
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nnCompletes initial and continued stay reviews in a timely manner, in accordance with various payor contracts and guidelines.
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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 data bases to support Clinical Resource Management components for each patient in assigned caseload. Identifies, track and trends Avoidable/Delay Days in Midas System.
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nnMonitors length of stay and ancillary resources use on assigned patient caseload.
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n nRequired Qualifications
nnnGraduate of an accredited Nursing Program.
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nnThree (3) years of clinical experience in healthcare or recent case management experience.
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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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nnProficient documentation skills.
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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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nnExcellent negotiation skills. Strong analytical, data management, and PC skills.
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nnCurrent working knowledge of utilization management, case management, and discharge planning.
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nnCurrent working knowledge of community resources, post-acute services.
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n nPreferred Qualifications
nnnRecent Acute Care experience.
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nnBachelor’s Degree in Nursing.
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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 with renewal
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nnCase Management Certification preferred.
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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
nnnIncumbents will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
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nnTravel may be expected locally between Independence Health locations.
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n nEqual Employment Opportunity
nIndependence Health and its affiliated companies are Equal Opportunity Employers. It is their policy to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran status, or genetic information, or any other classification protected by law. Independence Health and its affiliated companies will comply with all applicable laws and regulations.
nDisclaimer
nThis job description is not designed to contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Moreover, duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.
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
nx
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nHead Protection (hard hat)
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nHearing Protection
nX
nHand Protection
nx
nx
nFeet, Toe Protection
nx
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nBody Protection
nx
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nLatex Exposure
nx
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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
nx
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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
nx
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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.
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.