RN Case Manager

4 weeks ago


Indian Hills, Kentucky, United States Highmark Health Full time
Job Summary

This position is responsible for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum. The RN Case Manager 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- 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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