Job Description

Job Title: Care Manager (RN) - Skilled Nursing
Job ID: 684917
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Nursing Administration
Location: 351 Causeway Dr, Franklin PA 16323

Description

Are you an experienced Long-Term Care nurse looking to start or further your career in care management? Sugar Creek Station is looking for a full time Care Manager to support their Nursing Administration department.

The Care Manager is responsible for coordinating and communicating the discharge plan for targeted residents, promoting delivery of the right care in the right setting and assuring appropriate processes and regulations are followed related to third party payers and financial plans.

Responsibilities:
  • Acts as liaison with Red Cross and National Nurse Aide Assessment Program.
  • Apply clinical knowledge to determine if resident requires a change in level of care or care setting and communicates with physicians and third party payers to facilitate appropriate level of care changes.
  • Call payors to obtain authorizations, interpret insurance benefits, review levels of care, and provide requested information.
  • Collaborate with the interdisciplinary team to facilitate appropriate discharge.
  • Consult with the Physician Advisor when needed to address medical decisions requiring review.
  • Coordinate and facilitate resident progression throughout the continuum of care.
  • Coordinates appropriate inservicing for all staff.
  • Educate residents/families and interdisciplinary team regarding third party payor requirements and other aspects related to benefit coverage. e.g., notices of non-coverage.
  • Ensure current understanding of guidelines and requirements of payors, external agencies, and regulations.
  • Instructs individuals in Nurse Aide training classes.
  • Maintains training records, statistics and documentation and prepares required reports.
  • Obtain consent to appeal on behalf of the resident on all final outcome of denial situations.
  • Oversees training for OSHA mandated areas
  • Perform daily clinical review utilizing InterQual criteria as a guide to validate whether resident meets admission or continued stay criteria.
  • Perform daily medical record reviews, monitoring appropriate length of stay to meet care needs, identifying barriers to discharge, and collaborating with external case managers.
  • Prepares and distributeds training aids such as instructional material, handouts, evaluation forms and visual aids, sets up audiovisual equipment, etc.
  • Promote resident safety.
  • Researches, plans, organizes and conducts training programs for all levels of employees.
  • Writes material for new training programs.

Qualifications

  • 2 years nursing experience in Long-Term Care/Acute Care setting required 
  • Knowledge of Long-Term Care requirements/criteria, strongly preferred
  • Admissions experience preferred
  • BSN and/or Bachelors degree in health related field preferred
Licensure, Certifications, and Clearances:
  • CPR or BLS within 30 days of beginning employment. 
  • CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
  • Act 34 Criminal Clearance
  • Basic Life Support or Cardio Pulmonary Resuscitation
  • Older Adult Protective Services Act
  • Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $22.11 to $37.86

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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