Part-time Care Manager (RN) - Float (UPMC Harrisburg/Community/West Shore)

$68,453 - $106,184/Yr

University of Pittsburgh Medical Center - Harrisburg, PA

Part-time

Harrisburg, PA

Hospitals

About the position

The Part-time Care Manager (RN) - Float position at UPMC Harrisburg involves coordinating clinical and financial plans for patients, performing utilization management, and facilitating discharge planning. This role emphasizes a good work/life balance with no on-call requirements, allowing the Care Manager to utilize critical thinking skills to assist patients effectively. The position requires collaboration with a multi-disciplinary team to ensure safe and appropriate discharge plans are developed and executed.

Responsibilities

• Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination.
• Collaborates with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge.
• Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services.
• Uses InterQual criteria to justify appropriate LOC and obtain all necessary payer authorizations for post-acute care.
• Serves as resource to clinical and finance teams for clinical documentation requirements and insurance coverage issues.
• Attends Department meetings and Corporate Care Management Training sessions to maintain current knowledge of payer and regulatory requirements.
• Promotes patient safety and supports CORE measures information for JCAHO requirements.
• Takes leadership role in concurrent denial process and works with Care Management Director and clinical team to support LOC.
• Starts discharge planning on admission and ensures DC documentation is completed and updated regularly.
• Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care.

Requirements

• Graduate of approved school of nursing.
• Two (2) years of nursing experience required.
• Current licensure as a Registered Professional Nurse in the state where the facility is located or in a state covered by a licensure compact agreement.
• Employees practicing in Pennsylvania must complete UPMC Corporate Care Management Training Certificate of Completion within 4-6 weeks of hire.

Nice-to-haves

• BSN or related Bachelor's degree preferred.
• Previous case management experience preferred.
• Knowledge of healthcare financial and payor issues preferred.
• Knowledge of state, local, and federal programs preferred.
• Use of InterQual criteria preferred.

Benefits

• Generous sign-on bonus
• Flexible scheduling with approximately one weekend per month and holidays mostly voluntary.