Registered Nurse (RN) - Case Manager

Lifepoint Health • Meyersdale, PA

19h

About The Position

Conemaugh Meyersdale Medical Center is part of
Lifepoint Health
[https://lifepointhealth.net/locations], a diversified healthcare delivery
network with facilities coast to coast. We are driven by a profound commitment
to prioritize your well-being so you can provide exceptional care to others. As
a Registered Nurse (RN)
joining our team, you’re embracing a vital mission
dedicated to making communities healthier
®. Join us on this meaningful journey
where your skills, compassion and dedication will make a remarkable difference
in the lives of those we serve.

More about our team

Conemaugh Meyersdale is a National Quality Program–designated hospital committed
to providing exemplary, community‑focused care. Our highly supportive and
collaborative team—including close partnership with case management—embraces a
“no one works alone” culture, ensuring seamless care coordination for patients
and families. Leadership leads with compassion and purpose, supported by a
structured orientation designed to set every team member up for success.

Requirements

• current state RN license
• Graduate of an accredited nursing school
• Diploma, Associates or Bachelor’s degree in Nursing
• A minimum of three (3) years experience as a professional Nursing or one (1) year Registered Nurse experience with Case Management
• Certification in BLS, ACLS and PALS within one year of employment

Nice To Haves

• Case Management experience preferred
• Certification in Case Management preferred

Responsibilities

• Promotes patient safety and quality
• Knowledgeable in all patient coverage from Swing Bed days to Admitted and Observation requirements along with Medicare discharge reviews
• Works closely with Providers, insurance companies and Medicare for medical review of cases
• Manages the denial process; Communicates with insurance companies and assists with Peer to Peer process and written appeals
• Facilitates daily IDT meetings
• Reviews admissions and verifies status for appropriateness
• Obtains authorizations
• Manages observation patients
• Applies 2-Midnight Rule
• Ensures compliance with CMS IM 1 & IM
• Keeps forms and documents up to date and ensure compliance with usage
• Tracks length of stay and readmissions and provides reviews
• Monitors readmissions
• Utilizes the NAVINET program for admission and discharge of Blue Cross patients
• Utilizes UPMC portal for authorizations and updates of UPMC patients
• Leads discharge planning and assessment for all patients
• Arranges for appropriate DME & DME face to face process; Assists with ER patients as needed for DME, Home Health referrals or placement needs.
• Arranges for home health & other appropriate community resources
• Completes recertification requirements over 96 hours
• Keeps current with the updated InterQual guidelines
• Follows ER transfers for potential post-acute Swing Bed program patient admission
• Reviews referred swing bed patients for appropriateness to ensure criteria is met
• Maintains positive communication with Providers and Case Management
• Obtains certification and develops goals and discharge assessment with plan for Swing Bed patients
• Completes recertifications for Swing Bed patients at 14 &30 days
• Completes follow up phone calls for all patients discharged home
• Maintains required stats and reports stats out to committees
• Completes monthly departmental dashboards
• Completes DCM to O slides each month and participates in the completion of the monthly quality report
• Understand the insurance contract process
• Works in conjunction with COO to develop and implement Swing Bed Program; Utilization Management Policy; Discharge Planning Process; Readmission (7 & 30 day) Policy; update policies as required

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• 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 This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree