RN - Inpatient Case Manager; Daylight), Jefferson

GENERAL OVERVIEW

This role involves creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum. The incumbent will use nationally recognized case‑management standards, collaborate with providers, clinical teams, health plans, and external partners, and advocate for patients and caregivers to align goals and plans. The position serves as a professional role model and key team member in managing readmissions, length of stay, ED utilization, and patient/family satisfaction.

• Contribute to or complete comprehensive assessment of patients and families, including clinical needs, social determinants of health, and economic barriers (20%).
• Identify barriers and analyze situations for the assigned patient population, including admission/readmission risk and resource capacity, to determine safe transition and care coordination plans (20%).
• Coordinate clinical care with the patient, family, provider(s), and interdisciplinary team (25%).
• Advocate for patients and families through effective communication with providers, interdisciplinary team members, payers, and post‑acute partners (15%).
• Leverage industry standards to educate patients, families, providers, and team partners on care appropriateness, documentation, utilization review, insurance benefits, transition planning, length of stay, and resource utilization (10%).
• Seek professional development through certification, mentoring/precepting, and committee participation (5%).
• Adhere to hospital and clinical setting policies, procedures, regulations, and requirements (5%).

Minimum

• Bachelor’s Degree in Nursing OR Bachelor’s Degree and Nursing Diploma OR 6 years of relevant experience in lieu of a degree
• 3 years in a clinical nursing role
• Current State of PA RN licensure OR multi‑state licensure via the eNLC
• Professional Certification within 5 years of start date (remaining by 12/31/2025)
• Critical thinking and problem‑solving
• Flexibility and adaptability to change
• Strong communication and collaboration skills tailored to providers, peers, clinical team members, patients, and families
• CPR – American Heart Association
• Act 34 Criminal Background Clearance Certificate
• Act 33 Child Abuse Clearance Certificate
• Act 73 FBI Fingerprinting Criminal Background Clearance Certificate

Preferred

• Nationally recognized Case Management Certification
• Transition planning and community/facility resource understanding
• Knowledge of motivational interviewing techniques
• BSN

• ACM Certification (Accredited Case Manager)
• Case Management – American Board of Occupational Health Nurses (ABOHN) and Certified Case Manager (CCM)
• Commission for Case Manager Certification (CCMC)

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

As part of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information. All employees must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) and the company’s data security guidelines.