Job Description

Job Title: Care Manager - Mon-Fri (7:30am-3:00pm)
Job ID: 734680
Status: Full-Time
Regular/Temporary: Regular
Hours: 7:30 a.m. to 3:00 p.m.
Shift: Day Job
Facility: UPMC Susquehanna The Green Home
Department: Nursing Services
Location: 37 Central Avenue, Wellsboro PA 16901

Description

Are you a caring and compassionate Registered Nurse with a special place in your heart for the older geriatric population? If you are searching for an opportunity to have variety in your day and to be challenged as a nurse, our Skilled Nursing and Rehabilitation Center at The Green Home could be the perfect fit for you!


The Green Home is located in Tioga County and is across the street from UPMC Susquehanna Soldiers & Sailors. We provide high quality care for our residents and exceptional rehabilitation and skilled nursing services for short and long term patients. The Green Home at UPMC Susquehanna is a 120 bed unit that provides short or long-term rehabilitative resident programs in our state-of-the-art rehabilitative facility. 


Purpose:

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
  • Basic Life Support
  • Cardio Pulmonary Resuscitation
  • Older Adult Protective Services Act
  • Registered Nurse
  • Registered Nurse

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

Salary Range: $28.33 to $43.91

Union Position: No

Apply Current Employee?

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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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DIGNITY & RESPECT
CARING & LISTENING
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