Registered Nurse, RN, Case Manager
Case Management
Full Time, Days, Monday-Friday
Sellersville, PA 18960
Responsibilities
The Registered Nurse, RN, Case Manager is responsible for the overall coordination of care for an assigned caseload. Concurrent and retrospective clinical review of inpatient medical records to evaluate the utilization of acute care services. Specific reviews are determined both internally and by requirements/requests of external payers or regulatory agencies and play a significant role in obtaining reimbursement for acute care services. The goal of the Registered Nurse, RN, Case Manager collaborates with patients, families and healthcare providers to promote health and manage illness. The Registered Nurse, RN, Case Manager facilitates the use of assessment, coordination and education to achieve quality patient care outcomes while coordinating interdisciplinary, comprehensive and cost-effective care across the continuum.
Essential Functions:
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Advocates for the patient by expediting post-acute placement and/or discharge logistics.
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Confirms receipt of electronic referral for discharge logistics (DME, home health, hospice, transportation, post-acute placement, etc.).
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Obtains and processes activities that prepare for post-acute transition, such as completing necessary forms, authorizations, reports, patient signatures and requisitions, as needed.
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Partners with the interdisciplinary team to implement post-acute placement for SNF, rehab, sub-acute, assisted living facility or other discharge logistics as ordered.
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Confirms patients' benefits, identifies preferred providers and uses knowledge of community availability to affect timely disposition.
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Confers with case management to prioritize discharge requests.
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Completes and transmits necessary forms to facilitate placement of patient.
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Uses electronic software to distribute post-acute placement requests to regional resources and identify availability.
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Establishes and maintains routine communication with referring interdisciplinary team to keep them informed of the progress of their request.
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Identifies any obstacles to timely transition and collaborates with the case manager to resolve the issue. Records avoidable days in the electronic software as it applies.
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Documents placement in the electronic software as it applies.
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In collaboration with the requesting clinician, arranges safe transportation that best fits the patient's needs and financial resources.
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Updates all involved parties regarding progress, revisions and other information related to implementing the plan.
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Reports any quality issues encountered with preferred providers that require follow-up.
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Facilitates prompt processing of all requests for post-acute services, including durable medical equipment (DME) or appointments with community resources.
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Collaborates with the patient and interdisciplinary team to coordinate follow-up appointments for patients with their primary care physician and/or specialist provider.
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Documents appropriate referrals and/or appointments in the electronic medical record prior to discharge.
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Resolves any pre-certification, registration or form completion prior to setting up an appointment with a community provider.
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Participates in follow-up processes to discharged patients to query about quality and timeliness of post-acute arrangements.
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Demonstrates independent problem-solving skills on behalf of the case management team and the patient.
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Professionally responds to payer's request for information.
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Utilization review and departmental support activities:
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Reviews in-house observation patients and provides the Medicare Outpatient Observation Notice (MOON). Documents completion in the electronic software as it applies.
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Reviews anticipated discharges and provides appropriate Medicare patients with the Important Message from Medicare (IMM) follow-up notice. Documents completion in the electronic software as it applies.
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Escalates any patient questions regarding the MOON and/or IMM in a timely manner to the care coordinator and/or utilization review nurse.
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Supports and assists with clerical duties as needed within the department by:
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Receiving and relaying messages to/from the care management team to other areas in the hospital and community, and providing information whenever possible to reduce interruptions.
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Reports sentinel events and quality of care issues to the department leadership team.
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Collects and tracks data as determined.
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Participates in performance improvement activities as indicated.
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Articulates the organization and program mission and goals.
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Demonstrates the ability to effectively manage time.
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Attends and participates in daily huddles and monthly departmental meetings.
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Demonstrates knowledge of and adheres to all organization and department policies and/or procedures.
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Promotes program stability, reputation and growth by coordinating positive teamwork with colleagues.
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Appropriately receives constructive guidance from senior staff and/or leadership.
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Preserves the basic human rights of expression, decision, action, confidentiality and personal dignity for all patients and families.
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Respects the cultural diversity of all patients, families and employees.
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Demonstrates effective team-building activities.
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Demonstrates mature negotiation and conflict-management strategies and skills.
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Demonstrates effective use of critical thinking skills to independently solve problems.
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Demonstrates knowledge of current regulatory and accrediting agency requirements as they pertain to obtaining services for patients.
Qualifications
EDUCATION AND EXPERIENCE:
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Associate's degree in Nursing required.
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Bachelor's degree in Nursing preferred.
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Needs knowledge of utilization review, case management, DC planning, care coordination, precertification of hospital days and post-acute care services.
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Prefer 3-5 years of acute care hospital experience and 2 years of acute care case management experience.
LICENSES AND CERTIFICATIONS:
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Registered Nurse in PA – licensed, upon hire, required.
BENEFITS:
We offer a competitive salary and comprehensive benefits to part-time and full-time employees, including:
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Medical, dental and vision insurance available first of the month after start date
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Wellness and gym discounts and free cardiac rehab gym
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403b
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On-site discounted child care center
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Paid time off
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Sick time for full-time employees
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Tuition assistance
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Free life insurance for full-time employees
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Long-term disability for full-time employees
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Short-term disability
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Employee referral bonus
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Identity theft insurance
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Pet insurance
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Flexible spending accounts
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Employee discount program
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Employee assistance program
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Free parking
Grand View Health is an equal opportunity employer.
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