Job Description

Job Title: Case Manager/RN - The Green Home
Job ID: 688841
Status: Full-Time
Regular/Temporary: Regular
Hours: 8:00 AM - 4:30 PM
Shift: Day Job
Facility: UPMC Susquehanna Soldiers + Sailors
Department: Nursing Services
Location: 37 Central Avenue, Wellsboro PA 16901

Description

UPMC Susquehanna is currently seeking a Case Manager for The Green Home - long term care living facility in Wellsboro, PA! This is a fantastic opportunity for an individual with experience in long term care to utilize their expertise to coordinate resident care and directing discharges and referrals.

 

The Green Home has been providing both short-term rehabilitation and long-term care services to residents of Tioga County and the surrounding communities. Our staff is present 24/7, 365 days of the year to help patients achieve the highest possible level of independence, with the intention of bettering their quality of life. Whether recovering from surgery, injury or illness or no longer able to live safely at home due to age or illness, we assist our residents with the highest level of medical care and comfort.

 

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:

  • 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.
  • 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.
  • Obtain consent to appeal on behalf of the resident on all final outcome of denial situations.
  • 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.
  • Promote resident safety.

Qualifications

2 years nursing experience in LTC/Acute Care setting required.

BSN and/or Bachelors degree in health related field preferred.

Licensure, Certifications, and Clearances:
CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire.

  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance
  • Basic Life Support
  • Cardio Pulmonary Resuscitation
  • Older Adult Protective Services Act
  • Registered Nurse

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

Salary Range: $28.33 to $43.91

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!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

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