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Registered Nurse Case Manager
2 months ago
Penn Medicine is committed to our tripartite mission of delivering exceptional patient care, pioneering innovative research, and training the next generation of medical leaders. Working with this prestigious academic medical center involves collaboration with top-tier clinical, technical, and business professionals across various disciplines.
Every day at Penn Medicine, breakthroughs are made. Hearts are healed, hopeful news is delivered, and comfort is provided. Our employees shape our future each day. Are you ready to make a difference in your career?
Position Overview:
- The Case Manager plays a vital role in supporting the interdisciplinary team to facilitate patient care, aiming to enhance clinical outcomes and patient satisfaction while managing care costs and providing timely, accurate information to payors. This role integrates and coordinates utilization management, care facilitation, and discharge planning functions. Additionally, the Case Manager identifies areas for performance improvement, such as workflow efficiency, education, and patient satisfaction.
- Collaborate and maintain active communication with physicians, nursing staff, and other members of the multidisciplinary care team to ensure timely and appropriate patient management.
- Identify and resolve systemic issues that may impede diagnostic or treatment progress, proactively addressing delays and obstacles to discharge.
- Utilize approved clinical appropriateness criteria to monitor the suitability of admissions and continued stays, documenting findings according to departmental standards.
- Ensure all critical elements of the care plan are communicated to patients, families, and healthcare team members, documenting as necessary to guarantee continuity of care.
- Engage directly with patients and families to assess needs and develop personalized continuing care plans in collaboration with physicians.
- Document relevant discharge planning information in the medical record in accordance with departmental standards.
- Work collaboratively with the multidisciplinary team throughout all phases of the discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, education, and ongoing evaluation.
- Refer cases for social work intervention based on departmental criteria.
- Initiate and facilitate referrals for home health care, hospice, medical equipment, and supplies.
- Collect data on delays and other performance indicators, including Avoidable Days, as determined by management.
- Promote professional growth and development by fulfilling requirements for mandatory and continuing education, skills competency, and supporting departmental goals that contribute to organizational success; serve as a mentor and resource for less experienced staff.
- Communicate relevant clinical information, including admission reviews, concurrent reviews, and discharge planning needs, to third-party payors to secure optimal reimbursement.
- The Case Manager will:
- Monitor 100% of assigned inpatient admissions;
- Assess the medical appropriateness of patient admissions (severity of illness);
- Oversee the care plan and proactively identify barriers to its execution;
- Intervene to prevent delays in the care plan;
- Identify trends in inappropriate utilization due to delays in diagnostic testing, medical and surgical procedures, and physician management;
- Coordinate the flow of clinical information with third-party payors to ensure appropriate reimbursement and proactively identify potential denials to avoid non-appealable outcomes.
- Registered Nurse - NJ (Required)
- Certified Case Manager (Required)
- National Case Management certification preferred; or to be obtained within two years of employment.
- Bachelor of Arts or Science (Required)
- BSN degree required; a minimum of 3 years of Medical-Surgical experience is required; Case Management and Discharge Planning experience preferred.
At Penn Medicine, we believe that the best care for our patients begins with the best care for our employees. Our employee benefits programs are designed to help our staff achieve and maintain their health. We offer a comprehensive compensation and benefits package, including one of the finest prepaid tuition assistance programs in the region. Our employees are actively engaged and committed to our mission. Together, we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran, or any other status protected by applicable law.
