Description

Are you a Registered Nurse (RN) in the Harrisburg area looking for the next step in your career? Are you looking for a day shift position that values a good work/home balance? UPMC Harrisburg is looking for a RN Care Manager for their cardiac units. Care Managers are valued members of the interdisciplinary care team. 

Care Managers use their nursing knowledge and critical thinking skills to help patients and families without doing hands on care or heavy lifting. The Care Management Department is very supportive each other. We promote autonomy, support career growth through certification and develping staff from within. 

Schedule: Hours are Monday-Friday 8:30 am-5:00 pm, with flexibility for appointments. Work approximately once every 4 weekends. Rotate between day shift (8:30am to 5:00 pm) and evening shift (1:00 pm to 9:30 pm) on your weekend. Holidays are voluntary, unless there are not enough volunteers and then rotation. Full time staff that work a holiday earn 2.5x their pay or 1.5x their pay with a PTO day that can be used later.

Responsibilities:

• Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge. 
• Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.
• Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.)
• Obtains all necessary authorizations for level of care including admission and continued stay. Follows payer-specific requirements to obtain and document authorizations.
• Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination.
• Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.
• Collaborates with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge.
• Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services.
• Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.
• Attends Department meetings and Corporate Care Management Training

Qualifications

• Graduate of approved school of nursing.
• Two (2) years of nursing experience required.
• BSN or related Bachelors degree preferred.
• Previous case management experience preferred, but not required
• Knowledge of healthcare financial and payor issues helpful.
• Knowledge of state, local, and federal programs helpful.

The Care Manager who has the following skills will be an asset to our team:

• Good communication skills
• Strong critical thinking skills
• Organization
• Ability to prioritize your day/week
• Self-motivated
• Positive attitude

Licensure, Certifications, and Clearances:

• Current licensure as a Registered Professional Nurse either in the state where the facility is located or in a state covered by a licensure compact agreement with the state where the facility is located.
• UPMC approved Care Management certification preferred

Clearances must be dated within 90 days

• Registered Nurse (RN)
• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

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Our Values

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