RN Case Manager (Full Time)- AHN Wexford

Company

Allegheny Health Network

Job Description

General Overview

This job has responsibility for creating, implementing, and evaluating care
plans for patients and their families/caregivers across the health continuum.  
Incumbents 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.  Incumbents will serve as professional role models, utilizing
their expertise in care management to promote a collaborative professional
environment that optimizes outcomes, engages patients/caregivers in their
healthcare, and supports effective resource utilization.  Serves as key team
members in the management of readmissions, length of stay, ED utilization, and
patient/family satisfaction.              

Essential Responsibilities

* Contributes to or completes comprehensive assessment 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. (20%)
* 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. (20%)
* Coordinates the clinical care with the patient, family, provider(s), and
members of the interdisciplinary team. (25%)
* Advocates for patients and families through effectively communicating with
providers, interdisciplinary team members, payers, and post-acute partners to
assure effective outcomes and care. (15%)
* Leverage 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. (10%)
* Actively seeks professional development opportunities through professional
certification, mentoring/precepting, and/or participation on
department/hospital/system committees. (5%)
* Adheres to the policies, procedures, rules, regulations, and requirements of
hospitals and other clinical settings. (5%)

Qualifications

Minimum

• OR- Bachelor’s Degree and Nursing Diploma
• OR-

Preferred

* Nationally recognized Case Management Certification
* Transition planning and understanding of community and facility resources
* Knowledge of motivational interviewing techniques
* BSN

LICENSES or CERTIFICATIONS 

Required 

* None 

Preferred 

* ACM Certification (Accredited Case Manager) - American Case Management
Association - American Case Management Association
* Case Management - American Board of Occupational Health Nurses (ABOHN) and
Certified Case Manager (CCM)
* Commission for Case Manager Certification (CCMC)      

Disclaimer: The job description has been designed to indicate the general nature
and essential duties and responsibilities of work performed by employees within
this job title. It may not contain a comprehensive inventory of all duties,
responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and
behavioral expectations as set forth in the code of business conduct and company
policies.

As a component of job responsibilities, employees may have access to covered
information, cardholder data, or other confidential customer information that
must be protected at all times.  In connection with this, all employees must
comply with both the Health Insurance Portability Accountability Act of 1996
(HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and
Procedures as well as all data security guidelines established within the
Company’s Handbook of Privacy Policies and Practices and Information Security
Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s
Code of Business Conduct. This includes but is not limited to adherence to
applicable federal and state laws, rules, and regulations as well as company
policies and training requirements.

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 any
category protected by applicable federal, state, or local law.

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completing the application process, please contact the email below.

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HRServices@highmarkhealth.org [HRServices@highmarkhealth.org]

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