Technical diploma in Nursing mandatory; Bachelor's preferred
Experience in discharge planning or home care preferred
Background in case management or utilization review preferred
Pediatric or similar adult setting experience preferred
Strong communication and organizational skills necessary
Ability to work independently and with a team
Responsibilities
Determine medical necessity and appropriate care levels using clinical data and criteria
Collaborate with third party payers to validate admission criteria and prevent denials
Develop and implement effective discharge plans with healthcare teams
Assess and address patient and family needs for ongoing care post-discharge
Communicate discharge plans to patients and families, supporting their choices
Participate in care coordination and complex patient rounds
Identify high-risk patients and develop tailored care plans
Benefits
$2500 sign-on bonus
Onsite work schedule from Monday to Friday, 8 AM to 4:30 PM
Limited holiday commitment and few weekend shifts required
Access to educational programs and professional development opportunities
Supportive work environment with emphasis on team collaboration
Comprehensive health benefits and retirement plan options
Professional growth through participation in workshops and seminars
Full Job Description
SHIFT: Day (United States of America)
A Brief Overview
This RN position requires 5 years of previous RN work experience. It is Monday to Friday, fully onsite -8-4:30. There is a commitment of approximately one holiday per year and 4-6 weekend shifts annually.
There is a $2500 sign on bonus offered for this position.
Under the general supervision of the Director, the Case Manager provides clinically-based support to the delivery of effective and efficient patient care. Paces each case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned caseload. Partners with Social Workers and collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement. Uses criteria to confirm medical necessity for admission and continued stay. With the patient, family and health care team, creates a discharge plan appropriate to the patient's needs and resources.
What you will do
Determines medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, clinical criteria, and third party information. Intervenes when determinations are not in alignment with clinical information, clinical criteria or third party information to resolve the situation. Documents all case management interventions in the current electronic system (EPIC).
Validates admission and continuing stay criteria with third party payers as well as the Attending Physicians. Recommends alternative care sites where appropriate.
Collaborates with third party payers to prevent denial of payment and proactively addresses issues contributing to a potential denial. Intervenes to prevent the denial when possible.
Supports the effective prevention and management of denials, including providing requested information as part of the appeal process.
Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Uses knowledge of usual length of stay to initiate a plan for discharge.
Collaborates and communicates with patients/families related to reimbursement issues and to create a discharge plan. Supports the process of patient choice in establishing a discharge plan.
Uses clinical knowledge and knowledge of anticipate response to treatment to assess patient progression towards anticipated outcomes. Communicates and coordinates with the patient/family and health care team to intervene when progression is stalled or diverted. Addresses actual/potential barriers to discharge
Completes the interventions necessary for discharges to home with self-care, home with services or short term skilled nursing facility placement. Assembles necessary referrals, discharge summaries and pertinent information for discharge to home, placement, or transfer prior to the day of discharge.
Actively contributes to, participates in, and follows through on interventions identified in care coordination and complex patient rounds.
Identifies high risk patients and creates a collaborative plan to address their unique needs.
Other Responsibilities:
Adheres to established departmental policies, procedures, and objectives.
Enhances professional growth and development by accessing educational programs, job related literature, in-service meetings, and workshops/seminars.
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
Maintains established department/hospital/system policies and procedures, directives, safety, environmental and infection control standards appropriate to this position.
Demonstrates a courteous and professional manner through interactions with internal and external customers.
Integrates scientific principles and research based knowledge in decision making.
Exemplifies a professional image in appearance, manner and presentation.
Engages in self-performance appraisal, identifying areas of strength as well as areas for professional development.
Reserachers, selects and promotes adaptation of best practice findings to ensure quality patient care and optimal outcomes.
Adapts behavior as needed to the specific patient population, including but not limited to: respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style
Performs other related duties as assigned.
Education Qualifications
Technical Diploma Nursing Required
Bachelor's Degree Nursing Preferred
Experience Qualifications
At least five (5) years experience. Required
Previous experience with discharge planning or home care experience Preferred or
Prior experience as a Case Manager or Utilization Reviewer Preferred or
Previous experience in a pediatric setting or similar adult setting Preferred
Skills and Abilities
Excellent communication skills and demonstrated organizational skills.
Ability to work effectively with all departments and all levels of CHOP professionals.
Ability to work independently or within a team structure.
Must be very organized and able to work independently.
Ability to establish priorities among multiple needs, meet deadlines and maintain standards of productivity.
Knowledge of managed care admission process (i.e. verification of benefits, admissions notification).
Ability to effectively negotiate with internal and external providers of patient care services.
Sound problem solving skills.
Excellent customer service orientation and strong interpersonal skills.
Computer skills and a working knowledge of Word, Excel and Access.
Licenses and Certifications
Registered Nurse (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required
Accredited Case Manager (ACM) - American Case Management Association (ACMA) - - Preferred
Certified Case Manager (CCM) - Commision for Case Manager Certification - - Preferred
SALARY RANGE:
$101,300.00 - $129,100.00 Annually
Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.
At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.
About Children's Hospital of Philadelphia
The Children's Hospital of Philadelphia (CHOP) is a pediatric healthcare facility that provides a range of medical services to children and families. The hospital was founded in 1855 and is located in Philadelphia, Pennsylvania. CHOP has a team of over 16,000 employees, including doctors, nurses, and other healthcare professionals. The hospital offers services such as primary care, specialty care, and surgical services. CHOP is consistently ranked as one of the top children's hospitals in the US by U.S. News & World Report.
