RN Case Manager, Jefferson at Highmark Health

3 weeks ago


Indian Hills, Kentucky, United States DirectEmployers Full time

Job Summary:

This role is responsible for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum. The incumbent will utilize nationally recognized standards of practice for case management by collaborating with providers, clinical teams, health plans, and external partners while advocating for patients and caregivers in order to align goals and plans.

Key Responsibilities:

• Contributes to or completes 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 identifies barriers and analyzes 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.
• Coordinates the clinical care with the patient, family, provider(s), and members of the interdisciplinary team.
• Advocates for patients and families through effectively communicating with providers, interdisciplinary team members, payers, and post-acute partners to assure effective outcomes and care.
• Leverages 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 equivalent experience.
• 3 years in a clinical nursing role.
• Current State of PA RN licensure or equivalent.
• Professional Certification within 5 years of start date.

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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