St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
This position coordinates the clinical and financial plan for targeted patient assignments. The RN Case Manager (RN CM) performs overall utilization management, resource management, care coordination, routine discharge planning, and related duties. The RN CM works with the physician, social worker and multi-disciplinary care team to facilitate clinical pathways and achievement of desired quality and financial outcomes. The RN CM carries a caseload appropriate to the unit and/or patient population assigned. This position reports to the Director and/or Manager of Case Management.
JOB DUTIES AND RESPONSIBILITIES:
1. Assesses the patient’s needs, goals, and barriers in relation to the patient’s clinical condition, psychosocial environment, and socioeconomic resources.
2. Reviews Interqual Criteria applied by the central utilization team to screen the patient’s condition within 24-48 hours of arrival. Applies Interqual criteria to the Medicare population for screening, in the absence of 3 days thereafter.
3. Assures compliance with regulatory and payor source requirements regarding patient status and case management.
4. Acts as a liaison between the hospital, the attending physician and third party physician advisors.
5. Collaborates with the multidisciplinary team to plan, implement and evaluate the patient’s plan of care via daily rounds.
6. Manages length of stay by proactively identifying and mitigating issues and barriers to care and a successful discharge plan.
7. Actively addresses and monitors resource utilization using evidence based standards during the patient’s stay.
8. Uses electronic systems to accurately document case coordination and discharge planning in the medical record, finance, review and referral systems.
9. Collaborates with Business Office and Utilization Review staff to manage denial management processes and communicate with multidisciplinary team as appropriate.
10. Collaborates with the patient, family or other caregivers and the multidisciplinary team to design a discharge plan respective of the patient’s needs and goals. Re-evaluates and revises discharge plan of care as additional information is obtained or goals change.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting for one to two hours at a time, walk on all surfaces for up to five hours a day, and climb stairs. Must be capable of driving a car and have the ability to finger and handle objects frequently. Occasionally firmly grasp, twist, and turn objects with hands and fingers. May be required to lift, carry, push, and/or pull objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels and reaches above shoulder level. Staff must have the ability to hear as it relates to normal conversations and high and low frequencies and to touch as related to telephone and computer keyboard.
Graduate of professional nursing program, Registered Nurse with current license to practice in the State of Pennsylvania or seeking Pennsylvania licensure through reciprocity required, advanced degree preferred. Bachelor of Science in Nursing or other health related field required upon hire or transfer into position. MSN and/or Case Management Certification preferred.
TRAINING AND EXPERIENCE:
Extensive clinical knowledge (3-5 years or equivalent) of the targeted patient population is required. Previous case management experience is preferred. Experience in the use of InterQual criteria preferred. Ability to establish and maintain collaborative and effective working relationships required.
As needed, as schedule. Primary needs are weekdays 8a-4:30p, some weekend hours.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!
St. Luke's University Health Network is an Equal Opportunity Employer.