Care Manager
2 weeks ago
**Introducing a great opportunity to work with a cohesive team in a work environment that is both welcoming and supportive.** The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals and authorizations. Works with multi-disciplinary team in resource management, discharge planning and care facilitation. The RN in this position will be responsible for completing medical necessity reviews utilizing Indicia and InterQual criteria for admitted patients in our hospitals for insurance companies and utilizing payer (insurance) portals to submit and process approvals and denials. The expectation is that the RN understand disease processes and use critical thinking skills to document accurate descriptions of the medical need for insurance to approve an inpatient hospital stay. _Weekend and holiday work is expected, the schedule varies._ **Responsibilities:** + Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services. + Collaborates with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge. Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services. Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care. Documents Freedom of Choice re: post-acute services. + Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability. + Attends Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources. Ensures compliance with all payer and government regulations. + Promotes patient safety. Supports CORE measures information for JCAHO requirements. + Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial. + Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge. Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge. Documents all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.) Obtains all necessary authorizations for level of care including admission and continued stay. Follows payer-specific requirements to obtain and document authorizations. + Graduate of approved school of nursing. + Two (2) years of nursing experience required. + BSN or related Bachelors degree preferred. + Previous case management experience preferred. + Knowledge of healthcare financial and payor issues preferred. + Knowledge of state, local, and federal programs preferred. + Use of InterQual criteria preferred. **Licensure, Certifications, and Clearances:** + Current licensure as a Registered Professional Nurse either in the state where the facility is located or in a state covered by a licensure compact agreement with the state where the facility is located. + Employees practicing in Pennsylvania: UPMC Corporate Care Management Training Certificate of Completion required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse (RN) + Act 31 Child Abuse Reporting with renewal + Act 33 with renewal + Act 34 with renewal + Act 73 FBI Clearance with renewal *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. **UPMC is an Equal Opportunity Employer/Disability/Veteran**
-
Care Management Associate
6 days ago
Harrisburg, United States CVS Health Full timeBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...
-
Case Coordinator
3 weeks ago
Harrisburg, United States Care Crafter Home Care LLC Full timeJob DescriptionJob DescriptionCare Manager responsibilities include collaborating with the family of patients, monitoring patient recovery, and helping patients gain access to different health providers as needed. Ultimately, you will work directly with patients to help them improve their quality of life while in our health facilitiesResponsibilitiesInteract...
-
Sr. Professional Care Manager
3 days ago
Harrisburg, United States UPMC Full timeAre you a Registered Nurse (RN) seeking a new opportunity? Are you a Professional Care Manager looking for your next chapter? UPMC has a Sr. Professional Care Manager position open in the Harrisburg area. The Senior Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource management,...
-
Care Management Associate
3 days ago
Harrisburg, United States CVS Pharmacy Full timeProvide comprehensive healthcare management to facilitate delivery ofappropriate quality healthcare, promote cost effective outcomes andimprove program/operational efficiency involving clinical issues. Support comprehensive coordination of medical se Management, Associate, Medical Director, Healthcare, Support, Retail
-
RN Case Manager, Lancaster/York area
2 weeks ago
Harrisburg, United States Morning Star Hospice and Palliative Care Solutions Full timeMorning Star Hospice and Palliative Care Solutions - PA - Covering Lebanon, Lancaster, York, Cumberland, & Dauphin Counties What You Will DoAs a RN hospice case manager, you will provide and coordinate hospice nursing and palliative care to terminally ill patients, traveling to and providing care in their homes. You will collaborate with the attending...
-
Care Coordinator
2 weeks ago
Harrisburg, United States AbaCares Services Full timeJob DescriptionJob DescriptionThe home Care Coordinator oversees services provided to individuals in their homes and communities who need assistance caring for themselves due to old age, sickness, disability, and/or other inflictions. Home care may include assistance with the activities of daily living, housecleaning, laundry, meal preparation,...
-
Quality Assurance
2 weeks ago
Harrisburg, United States Petersen Health Care Full timeJob DescriptionJob DescriptionA Quality Assurance (QA) Nurse is a health care professional skilled in all phases of the nursing process. He/she is adaptable to the needs of the individual and family during health and illness and has the ability to prioritize. The Quality Assurance (QA) Nurseassesses, plans, implements and evaluates daily resident care and is...
-
Child Care Director
7 days ago
Harrisburg, United States Hansel & Gretel Early Learning Center Full timeOverview: At Hansel & Gretel Early Learning Center, every day brings something new. As a center director, we want you to take the opportunity to inspire the passion in your teachers, have a moment of pure connection with a child or parent, embrace an unexpected challenge that evolves into an opportunity to apply your intelligence, share your compassion and...
-
Food Service Assistant
7 days ago
Harrisburg, United States ProMedica Senior Care Full time**Food Service Assistant** Harrisburg, Pennsylvania 684 - Arden Courts of Susquehanna, Harrisburg, Pennsylvania ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 26 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and...
-
CRNP (PHSPC - Palliative Care)
7 days ago
Harrisburg, United States Pinnacle Health Systems Full timeSupportive Care and Palliative Medicine CRNP# # Opportunity: Join a successful program including 4 physicians and 8 certified nurse practitioners who provide consultative palliative care services including serious illness discussions, symptom management, and collaboration of care for patients with advanced medical conditions. Collaborate with consulting...
-
CRNP (PHSPC - Palliative Care)
4 days ago
Harrisburg, United States Pinnacle Health Systems Full timeSupportive Care and Palliative Medicine CRNP# # Opportunity: Join a successful program including 4 physicians and 8 certified nurse practitioners who provide consultative palliative care services including serious illness discussions, symptom management, and collaboration of care for patients with advanced medical conditions. Collaborate with consulting...
-
Analyst, Case Management
6 days ago
Harrisburg, United States CVS Health Full timeBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...
-
Med Tech
3 days ago
Harrisburg, United States Five Star Quality Care, Inc. Full timeKey Responsibilities The Opportunity We are seeking compassionate Certified Medication Aide to provide support for our community's residents with the essential day-to-day tasks they can no longer perform or need help with. Certified Medication Aide is responsible for administering daily medication residents. Duties include monitoring residents, reporting...
-
Caregiver
2 days ago
Harrisburg, United States Five Star Quality Care, Inc. Full timeKey Responsibilities At this time, we are seeking a Resident Assistant to join our team! Responsibilities * Gives report to the Nurse or designated charge person at the end of the shift. * Reports any changes to the Nurse or designated charge person immediately for determination of contacting the on-call Nurse. * Reminding residents to take medication,...
-
Physician, Palliative Medicine
4 days ago
Harrisburg, United States Pinnacle Health Systems Full timeSupportive Care and Palliative Medicine Physician # Opportunity: Join a successful program including 4 physicians and 8 certified nurse practitioners who provide consultative palliative care services including serious illness discussions, symptom management, and collaboration of care for patients with advanced medical conditions. Collaborate with consulting...
-
Manager of Workforce Development
4 hours ago
Harrisburg, United States University of Pittsburgh Medical Center Full timeThe Manager of Workforce Development at UPMC in Central Pa. plays a pivotal role in collaborating with secondary and post-secondary educational institutions to attract students to the health care field and promote our education programs for high-dema Workforce, Manager, Development, Health, Education, Vice President, Management, Healthcare
-
Registered Nurse
11 hours ago
Harrisburg, United States Avera@Home Sioux Falls Full timeJoin the RN Nursing team at Avera! Love Where You Work: Work at Avera where current employees rate their satisfaction at 94%. Join a team where the career opportunities are endless. Culture: Be part of a multidisciplinary team built on teamwork, with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter. You...
-
HealthCare Recruiter
4 days ago
Harrisburg, United States All American Home Care LLC Full timeAll American Home Care LLC is an EEO employer - M/F/Vets/Disabled JOB DESCRIPTION Healthcare Recruiter acts as the primary link between All American Home Care and a potential job candidate in the healthcare industry. With experience, the recruiter will be responsible for duties such as conducting interviews, reviewing resumes, and ensuring the...
-
Nurse Educator
10 hours ago
Harrisburg, United States UPMC Full timeThe Nurse Educator is a critical member of the nursing team and collaborates with the multi-disciplinary team for the Intermediate Care Unit nursing and nursing support team members. This role would oversee and coordinate educational opportunities for the UPMC Harrisburg Intermediate Care Unit. The Nurse Educator, a professional registered nurse, has the...
-
Care Give/Med Tech, pay rates from $15.50
1 week ago
Harrisburg, United States TerraBella Harrisburg Full timeJob DescriptionJob DescriptionTerraBella Senior Living is the proud operator of more than 30 plus, amenity-, care- and lifestyle-focused communities located throughout the Carolinas, Virginia, Kentucky, Georgia, and Tennessee. TerraBella communities together account for more than 2200 units and span a full spectrum of senior living and care options,...
