Care Manager / UR - AGH

Job ID: J116528
Company: West Penn Allegheny Health System
Location: Pittsburgh, PA, United States
Facility: Allegheny General Hospital
Full/Part Time: Full time
Job Type: Regular
Posted at: Feb 2, 2018

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Description

GENERAL OVERVIEW

Responsible and accountable for facilitating the provision of quality and cost-effective care delivery for a designated patient population during an acute episode of care. Ensures optimal care management, patient outcomes and reimbursement based upon enactment of the nursing process.

ESSENTIAL RESPONSIBILITIES

  • Coordinates the clinical care with the patient, family, physician(s), and other members of the interdisciplinary team. (50%)
  • Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients. (15%)
  • Develops and implements an effective discharge plan while incorporating input from the patient, family, physician(s), and other members of the interdisciplinary team. (20%)
  • Identifies, analyzes, collects, and communicates data relative to quality and cost issues related to the assigned patient population. (5%)
  • Expands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. (5%)
  • Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies. (5%)

QUALIFICATIONS

Minimum

  • BS/BA Degree Required.
  • Current license to practice professional nursing required.
  • Current CPR certification required.
  • Inpatient clinical nursing experience in an acute hospital setting with two (2) years experience in the population to which the individual is to be assigned required or 2 years relevant CM/UM experience in another healthcare setting.
  • Requires interpersonal, analytic, and critical thinking skills for problem solving and decision making, broad and intimate knowledge of reimbursement and regulatory requirements, decisive judgment and the ability to work with minimal supervision.
  • Must be able to work in a fast-paced environment requiring adaptability, flexibility and independence while demonstrating high professional standards, leadership, and team membership skills.

Preferred

  • Case Management certification preferred.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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