Care Manager

3 weeks ago


Harrisburg, Pennsylvania, United States UPMC Full time
Care Manager Job Description

The Care Manager plays a vital role in coordinating the clinical and financial plan for patients. This position requires strong communication and organizational skills to ensure seamless care transitions.

Key Responsibilities:
  • Reviews medical records daily to ensure patients meet LOC requirements and chart documentation supports LOC determination.
  • Collaborates with patients, caregivers, internal/external healthcare providers, agencies, and payers to plan and execute safe discharges.
  • Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services.
  • Uses InterQual criteria to justify appropriate LOC and obtain necessary payer authorizations for post-acute care.
  • Serves as a resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, and post-acute services coverage and availability.
  • Ensures compliance with all payer and government regulations.
  • Promotes patient safety and supports CORE measures information for JCAHO requirements.
  • Takes a leadership role in concurrent denial process.
Requirements:
  • Graduate of an approved school of nursing.
  • Two (2) years of nursing experience required.
  • BSN or related Bachelor's 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.
  • UPMC Corporate Care Management Training Certificate of Completion required with 4-6 weeks of hire.
  • UPMC approved Care Management certification preferred.
  • Advanced Cardiac Life Support (ACLS).
  • Registered Nurse (RN).
  • Act 34 with renewal.

  • Care Manager

    2 weeks ago


    Harrisburg, Pennsylvania, United States UPMC Full time

    Job SummaryWe are seeking a skilled Care Manager to join our team at UPMC. As a Care Manager, you will play a critical role in coordinating the clinical and financial plan for patients, ensuring they receive the necessary care and resources to achieve optimal health outcomes.Key ResponsibilitiesReview medical records daily to ensure patients continue to meet...


  • Harrisburg, Pennsylvania, United States Complete Home Care Full time

    Job Title: Experienced Home Care AdministratorWe are a dynamic and growing non-medical home care agency, part of a regional brand, seeking an experienced Home Care Administrator to oversee our Harrisburg office.The ideal candidate will have prior experience in Home Care management and knowledge of working with home care agencies within the state of PA. They...

  • Nurse Care Specialist

    4 weeks ago


    Harrisburg, Pennsylvania, United States BAYADA Home Health Care Full time

    Registered Nurse (RN) OpportunityWe are seeking a skilled Registered Nurse (RN) to join our team at BAYADA Home Health Care. As a RN, you will have the opportunity to work with a diverse range of clients, providing high-quality care and support in the comfort of their own homes.Responsibilities:Develop and implement personalized care plans to meet the unique...

  • Nurse Care Specialist

    1 month ago


    Harrisburg, Pennsylvania, United States BAYADA Home Health Care Full time

    Job SummaryBAYADA Home Health Care is seeking a skilled Registered Nurse to join our team as a Home Health Care Professional. As a Nurse Care Specialist, you will provide high-quality patient care in the comfort of their own homes.Key ResponsibilitiesDevelop and implement personalized care plans in accordance with patient needs and goals.Conduct thorough...


  • Harrisburg, Pennsylvania, United States All American Home Care LLC Full time

    Job Summary:We are seeking a highly skilled and compassionate Patient Care Coordinator to join our team at All American Home Care LLC. As a Patient Care Coordinator, you will be responsible for providing coordinated care to patients by developing, monitoring, and evaluating their home health care plans. You will ensure a high level of care for the patient...

  • RN Care Coordinator

    3 weeks ago


    Harrisburg, Pennsylvania, United States Highmark Health Full time

    Job SummaryThis RN Care Coordinator role is responsible for coordinating care and managing the coordination of care in accordance with recognized standards of practice for Care Management. The incumbent will utilize expertise in care management to promote a collaborative professional environment that supports excellence of care and achievement of optimal...

  • RN Care Coordinator

    2 weeks ago


    Harrisburg, Pennsylvania, United States Highmark Health Full time

    Job SummaryThis RN Care Coordinator role is responsible for coordinating care and managing the coordination of care in accordance with recognized standards of practice for Care Management. The incumbent will utilize expertise in care management to promote a collaborative professional environment that supports excellence of care and achievement of optimal...


  • Harrisburg, Pennsylvania, United States All American Home Care LLC Full time

    Job SummaryWe are seeking a highly skilled Patient Care Coordinator to join our team at All American Home Care LLC. As a Patient Care Coordinator, you will be responsible for providing coordinated care to patients by developing, monitoring, and evaluating their home health care plans.Key Responsibilities:Develop and implement individualized care plans for...

  • Care Coordinator

    4 weeks ago


    Harrisburg, Pennsylvania, United States All American Home Care LLC Full time

    Job Summary:We are seeking a skilled Care Coordinator to join our team at All American Home Care LLC. As a Care Coordinator, you will play a vital role in providing coordinated care to patients by developing, monitoring, and evaluating their home health care plans.Key Responsibilities:Develop and implement individualized care plans for patientsCoordinate...


  • Harrisburg, Pennsylvania, United States AmeriHealth Caritas Full time

    Job Title: Behavioral Health Care ManagerWe are seeking an experienced Behavioral Health Care Manager to join our team at AmeriHealth Caritas. This is a 100% remote position, and we prefer candidates who are licensed in the state of Pennsylvania.About the Role:The Behavioral Health Care Manager will be responsible for providing utilization management and...


  • Harrisburg, Pennsylvania, United States AmeriHealth Caritas Full time

    Job Title: Behavioral Health Care ManagerAmeriHealth Caritas is seeking an experienced Behavioral Health Care Manager to join our team. As a core participant of the collaborative care team, you will be responsible for providing utilization management and case and care management, as well as supporting and coordinating the behavioral health care of...


  • Harrisburg, Pennsylvania, United States All American Home Care LLC Full time

    Job SummaryWe are seeking a highly skilled Patient Care Coordinator to join our team at All American Home Care LLC. As a Patient Care Coordinator, you will play a critical role in providing coordinated care to patients by developing, monitoring, and evaluating their home health care plans.Key Responsibilities:Develop and implement home health care plans that...


  • Harrisburg, Pennsylvania, United States All American Home Care LLC Full time

    About the RoleWe are seeking a highly skilled and compassionate Care Manager to join our team at All American Home Care LLC. As a Care Manager, you will play a vital role in ensuring the highest level of care for our patients by developing, monitoring, and evaluating their home health care plans.Key ResponsibilitiesDevelop and implement individualized care...


  • Harrisburg, Pennsylvania, United States Dauphin County Pennsylvania Full time

    Aging Care Management Supervisor 1 Job DescriptionThis is a merit hire position with a competitive hourly rate of $22.05 per hour. Dauphin County Area Agency on Aging is currently accepting applications for a full-time, day shift Aging Care Management Supervisor 1 position.Job SummaryThe Aging Care Management Supervisor 1 is responsible for supervising Care...


  • Harrisburg, Pennsylvania, United States AmeriHealth Caritas Full time

    Job OpportunityAmeriHealth Caritas is seeking an experienced Behavioral Health Care Manager to join our team. This is a 100% remote position, and we prefer candidates who are licensed in the state of Pennsylvania.The successful candidate will be responsible for providing utilization management and case and care management services to our members. They will...

  • Nurse Care Manager

    3 weeks ago


    Harrisburg, Pennsylvania, United States Homeland Center Full time

    Charge Nurse (LPN) OpportunityWe are seeking a compassionate and skilled Licensed Practical Nurse to join our team as a Charge Nurse at Homeland Center. As a Charge Nurse, you will play a vital role in providing high-quality care to our residents and patients.ResponsibilitiesManage and provide direct care to residents, including administering medications and...

  • Nurse Care Manager

    2 weeks ago


    Harrisburg, Pennsylvania, United States Avera@Home Sioux Falls Full time

    Transformative Care ModelAvera McKennan's innovative program brings acute hospital-level care to adults and older adults in the comfort of their own homes, rather than in a traditional hospital setting. This approach improves outcomes and increases patient satisfaction by addressing their health needs in a patient-centered way.Positive Work EnvironmentOur...

  • Care Manager

    4 weeks ago


    Harrisburg, Pennsylvania, United States UPMC Full time

    Care Manager Job SummaryWe are seeking a skilled Care Manager to join our team at UPMC. As a Care Manager, you will play a critical role in coordinating the clinical and financial plan for patients, ensuring seamless transitions and optimal outcomes.Key Responsibilities:Review medical records daily to ensure patients meet LOC requirements and chart...

  • RN Care Coordinator

    3 weeks ago


    Harrisburg, Pennsylvania, United States Highmark Health Full time

    Job SummaryThis role is responsible for coordinating care and managing the coordination of care in accordance with recognized standards of practice for Care Management. The incumbent utilizes expertise in care management to promote a collaborative professional environment that supports excellence of care and achievement of optimal resource utilization.The...

  • RN Care Coordinator

    3 weeks ago


    Harrisburg, Pennsylvania, United States Highmark Health Full time

    Job SummaryFrequent travel and virtual visits in an assigned territory are key components of this role. As a RN Care Coordinator, you will be responsible for coordinating care and managing the coordination of care in accordance with recognized standards of practice for Care Management.This role requires expertise in care management to promote a collaborative...