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Registered Nurse - Case Management

  • Job ID: 421541783
  • Status: Full-Time
  • Regular/Temporary: Flex
  • Hours: 8:00 a.m. to 4:30 p.m.
  • Shift: Day Job
  • Facility: UPMC Altoona
  • Department: Case Management
  • Location: 620 Howard Avenue, Altoona PA 16601
  • Union Position: Yes
  • Salary Range: $0 / hour

Description

Registered Nurse
Case Management
.7 Flex Full-Time Day shift with some variation in shift time (rotating weekends)
SEIU
POSTED: 11/27/2020

UPMC Altoona is seeking a Registered Nurse to join our Case Management team. This position is on day shift, 8am to 4:30pm, shift times may vary, rotating weekends.

Purpose:

Provides clinically-based review of patient's record, provides InterQual Criteria, makes appropriate referrals to Care Coordinators and assures appropriate utilization of resources for patients. Assures that the requirements of Medicare, Medical Assistance and third-party payor contracts are met and that the medical staff are informed at all times of governmental regulations.

Responsibilities:
  • Adequately documents on multi-disciplinary forms, non physician progress notes, discharge instruction sheet and worksheets. Documentation: UR documentation using Canopy Software
  • Financial Awareness and Responsibility: a. Knowledge of clinical documentation and its effect on reimbursement. b. Coding knowledgec. Awareness of case mix index and length of stay.
  • Completes patient assessment using the medical record and multi-disciplinary team interaction. Review process must include: a. Clinical Assessment b. Application of standard criteria c. Referral to a physician advisor as needed
  • Ability to apply InterQual Criteria appropriately. 
  • Able to complete accurate review to obtain clinical information to complete the certification process with all payors. 
  • Basic understanding of payment modalities (DRG vs per diem).
  • Adheres to denial process as outlined in manual.
  • Validate referrals with physician.
  • Utilization Review: a.Review using InterQual Criteria b. Certification c. Reimbursement d. Denial Process e. Physician Advisor referrals/Executive Health Resources
  • Review of medical record and validation with Physician Advisor and/or Risk Manager. Documentation and Quality Assurance: a. Able to identify appropriate standards of care. b. Conducts concurrent case reviewsc.
  • Monitors for quality issuesd.
  • Makes appropriate referrals to Physician Advisor or Risk Manager when standards of care not met.
  • Validate appropriateness of referrals with the hospital attorney, Risk Manager and Quality Assurance Director.
  • Risk Management: a. Able to identify practices and/or events that jeopardize patient safety. b. Report to hospital attorney, Risk Manager or Quality Assurance Director as needed.
  • Discharge Process: a. Works with the Care Coordinator providing clinical input as needed to develop an appropriate discharge plan. b. Current knowledge of discharge options and reimbursement methods

Qualifications

Must be a graduate of an accredited school of nursing holding a valid registration as a registered nurse in the Commonwealth of Pennsylvania.Experience Required:Five years experience as a registered nurse in a hospital setting. Must be proficient in using Alpha, Cerner, CPOE, and Tele TrackingMust have extensive clinical background and knowledge not confined to one specialty or area. Critical Care background preferred. Management experience preferred. Accurate typing and spelling skills 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

  • Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
  • Registered Nurse (RN)
  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

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