Registered Nurse; RN - Case Manager

Registered Nurse (RN) - Case Manager

Job Type: Full Time | M-F 730-400 or 8-430 + rotating weekends + on call

Your experience matters

Conemaugh Memorial Medical Center is part of Lifepoint Health, 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 Social Worker 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

The Utilization Management RN Case Manager (UM-RNCM) functions under the direction of the Case Management Manager. The UM-RNCM performs initial clinical documentation reviews on assigned patients to substantiate Severity of Illness and Intensity of Service based on Industry Standard Criteria. The UM-RNCM refers cases not meeting MCG Criteria to the physician advisors and follows through on cases to assure regulatory compliance.

Clinical information is relayed to the managed care companies to obtain authorizations for payment. The UM-RNCM is responsibility for correct status within the hospital and communication with physicians if a case is denied.

How you'll contribute

A Registered Nurse (RN) Case Manager who excels in this role:

* Skilled in Case Management functions and Care Coordination

* Utilizes Interqual or the 2MN rule to determine status for all patients assigned an acute care bed.

* Reviews medical records and provides accurate clinical information to payers for authorization.

* Collaborate with interdisciplinary team to facilitate progression of care and resource utilization.

* Proactively interacts with patients and families during the admission process to set expectations for the course of stay and length of stay.

* Proactively analyzes information from the care team to support inpatient admission.

* Assesses, identifies, and intervenes to reduce the risk of barriers that will interfere with the transition of care.

* Facilitates optimal care transition to reduce avoidable readmissions.

* Follows the Case Management policy & procedure for utilizing Physician Advisors.

* Interacts with attending physicians, physician advisor and department chairs about any identified quality issues and utilization issues.

* Leads Interdisciplinary Discharge Planning Rounds (IDTs) to determine appropriate concurrent care planning, resource utilization and appropriate post acute level of care determination.

* Identifies and documents avoidable days and intervenes promptly to remove identified barriers.

* Follows CMS & regulatory requirements for Case Management processes.

* Coordinates concurrent denial/appeal- (peer to peer) process for assigned cases.

* Assumes on-call and weekend duties as assigned.

* Assist floor(s) with transportation barriers during working hours.

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

* Comprehensive Benefits:
Multiple levels of medical, dental and vision coverage - with medical plans starting at just $10 per pay period - tailored benefit options for part-time and PRN employees, and more.

* 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 we're looking for

Applicants should have a current state RN license and possess an associate or bachelor's degree from an accredited nursing school. Additional requirements include:

* BLS Certification

* 3 years experience in acute care as a Professional Nurse or RN experience with significant acute care hospital Case Management experience

* Previous case management experience preferred

* Case management certification, CP preferred

More about Conemaugh Memorial Medical Center

Conemaugh Memorial Medical Center is a 537-bed behavioral health, rehabilitation, and transitional care hospital that has been offering exceptional care to the Johnstown community for over 135 years. We are proud to be recognized by the American Heart Association with the Stroke Gold Plus Quality Achievement Award.

EEOC Statement

"Conemaugh Memorial Medical Center is an Equal Opportunity Employer. Conemaugh Memorial Medical Center is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment."