RN - Case Manager, Emergency Department (Rotational)

3 weeks ago


Jefferson Hills, Pennsylvania, United States Highmark Health Full time
Job Summary:

Highmark Health is seeking a skilled RN - Case Manager, Emergency Department (Rotational) to join our team. As a key member of our case management team, you will be responsible for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum.

Responsibilities:

• Contribute to or complete comprehensive assessments of patients and their families/caregivers, inclusive of clinical/physical needs, social determinants of health, and economic barriers impacting their ability to manage their health.
• Effectively identify barriers and analyze situations for assigned patient population, including risk for admission/readmission, external resources, and patient/family capacity in order to determine safe plans for transition and care coordination.
• Coordinate the clinical care with the patient, family, provider(s), and members of the interdisciplinary team.
• Advocate for patients and families through effectively communicating with providers, interdisciplinary team members, payers, and post-acute partners to assure effective outcomes and care.
• Leverage understanding of industry standards to provide applicable education to patients, families, providers, and interdisciplinary team partners including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization.

Requirements:

• 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 Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
• Professional Certification within 5 years of start date
• Critical thinking and problem solving
• Flexibility and adaptability to change
• Strong communication and collaboration skills with ability to tailor style according to target audience (providers, peers, clinical team members, patients, 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 Qualifications:

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

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