Responsibilities:

The Case Manager coordinates, manages and procures the discharge needs of patients identified as requiring post-acute care services via initial admission screen, assessment and consults. This is achieved by collaboration with the family, the care team including physicians, nursing and other healthcare professionals. The Case Manager performs daily utilization review and conveys pertinent telephonic information to third party payers to secure appropriate acute care reimbursement within the time requirements of the payer. The Case Manager appeals 100% of all third party payer denials for acute care reimbursement according to the guidelines for the PA Region. The Case Manager performs ongoing PI/QA during concurrent review to identify quality of care issues, risk management issues, and performs blood/blood products and medication utilization.

Qualifications:

Education Requirements

· 4 year/bachelor's degree

Experience

· Relevant Experience

Certification and Licensure

· PA Registered Nurse License

Required Skills

· Computer Skills to include use and navigation.

· Excellent Communications Skills

· Excellent Interpersonal Skills

· Microsoft Word

Summary
The RN Case Manager position requires a skilled professional with a strong background in managed care, patient service, and nursing. The ideal candidate should possess in-depth knowledge of patient care, physiology, and medical terminology. Experience in hospital settings and proficiency in patient assessment and discharge planning are essential for success in this role. Premium skills such as critical care, ICU, and behavioral health experience would be advantageous. The candidate must hold a Bachelor's degree, an RN license, and demonstrate proficiency in Microsoft Word and computer skills. The RN Case Manager will play a crucial role in coordinating patient care, ensuring compliance with HIPAA regulations, and facilitating effective communication between healthcare providers and patients.

Job Type: Full-time

Pay: $80,000.00 - $100,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Work setting:

• Hospital

Application Question(s):

• A bachelor's degree is a must for this role. Do you have one?

Education:

• Bachelor's (Required)

Experience:

• Nursing: 1 year (Required)
• Case management: 1 year (Required)

License/Certification:

• RN (Required)

Ability to Commute:

• Philadelphia, PA (Required)

Ability to Relocate:

• Philadelphia, PA: Relocate before starting work (Required)

Work Location: In person