RN Case Manager

Commonwealth Health•Scranton, PA

1d•Onsite

About The Position

The individual in this position has overall responsibility for reviewing the clinical plan of care in comparison to evidence-based practice and regulatory requirements. The position integrates care coordination, utilization management, and discharge planning.

Requirements

Current Pennsylvania RN license in good standing.
Minimum of 3 years of clinical nursing experience.
Current Acute Care Case Management and/or Utilization Review experience required.
Minimum of one year of Charge nurse experience or related experience required.
Theoretical knowledge of the clinical processes, case management and continuity of care required.
Motivation for self direction.
General computer knowledge.
Ability to relate and work with chronically ill and disabled patients of all ages and with those with emotional disturbances.
Possesses the ability to handle sensitive situations.
Ability to relate to and work with various managed care representatives, defining the continuing need for medical treatment.
Ability to understand and integrate needs of the patient with available resources.
Ability to work closely with physicians and provide guidance regarding clinical guidelines and managed care organization requirements.

Nice To Haves

Bachelor’s degree in nursing or related field preferred.
Use of nationally recognized utilization review standards preferred.

Responsibilities

Medical necessity screening
Care coordination
Discharge planning
Facilitating multi-disciplinary patient care conferences
Managing concurrent disputes of payers about levels of care
Making appropriate referrals to other departments (e.g., nutrition, physical and occupational therapy)
Participating in weekly Complex Case Reviews
Arranging for post-discharge patient education
Clear, complete and concise documentation in case management software and hard copy documents
Maintaining accuracy of patient demographic and insurance information
Identifying and documenting potentially avoidable days
Identifying and reporting over and under utilization.