PRN Case Manager- STC

About the Organization

Tower Health is a strong, regional, integrated healthcare provider/payer system that offers leading-edge, compassionate healthcare and wellness services to a population of 2.5 million people. Together, our seven hospitals and other entities provide a full range of medical care from prevention, screenings & education; to the latest clinical services and surgeries available; to rehabilitation. We also offer wellness programs & public health services that ensure our communities are the healthiest they can be. Our caring, highly trained physicians and staff are committed to patient safety and patient satisfaction.

With more than 11,000 team members, Tower Health includes Reading Hospital, a teaching hospital based in West Reading; Brandywine Hospital in Coatesville; Chestnut Hill Hospital, a teaching hospital in Philadelphia; Jennersville Hospital in West Grove; Phoenixville Hospital in Phoenixville; Pottstown Hospital in Pottstown; and St. Christopher's Hospital for Children. We also operate Reading Hospital Rehabilitation at Wyomissing & Reading Hospital School of Health Sciences, & we have a comprehensive physician network.

Collaboration across Tower Health enables our hospitals, providers, leadership & staff to leverage best practices across the health system. Our hospitals have received national recognition for advanced care in areas such as neurosurgery and stroke, cardiac & vascular surgery, trauma, hematology & oncology. Reading HealthPlex, which opened at Reading Hospital in October 2016, combines state-of-the-art technology and world-class design to make the HealthPlex one of the most sophisticated surgical centers & inpatient facilities in the region.

At Tower Health, we have a rich history of providing high-quality, cost-effective care in the communities we serve. As the healthcare industry continues to change, one thing remains steadfast: Tower Health’s commitment to Advancing Health, Transforming Lives.

The PRN Case Manager wil ensure collaboration among multi-disciplinary teams (internal and external), the patient and caregivers. Ensuring the specific needs of the patient are met during their stay in the hospital and post discharge from the hospital. All Case Manager activities will be patient centered, proactive, require on-going assessment of needs, evaluation of resources, and education as needed. The Case Manager is responsible for presenting options in an unbiased manner and meeting compliance with HIPPA. Advocacy and education are at the heart of all activities focusing on providing the best possible clinical outcomes.

Essential Functions:

Utilization Management: Serve as a resource for the physicians and staff on level of care placement following InterQual guidelines. Complete initial and daily reviews for assigned patients.

Discharge Planning: Arrange discharge services from the hospital for patients who required Observation or an Admission level of care stay at the hospital. This includes but is not limited to; Home Care, Infusion, Skilled Nursing, Durable Medical Equipment, Oxygen Therapy, and referrals to outpatient services and agencies. Assessment and evaluation of the needs will be conducted by interviewing the patient and their caregivers in addition to reviewing current and prior functioning, medical record, psychosocial dynamics, and identification of their support system.

Implementation and Facilitation of Care Activities: The Care Manager will act in a proactive manner addressing real and potential needs to develop a comprehensive and cohesive plan patient centered plan. Additionally, the Case Manager will verify benefits and secure authorizations from the payer when indicated. The Case Manager acts as an advocate and mediator to ensure best patient outcomes.

Data Collection: The Case Manager participates in collection of information.

Behavioral Expectations: Exhibits consistent professional contact in interaction with all internal and external multidisciplines, patients/families, peers, and physicians while respecting HIPPA requirements. Take ownership for errors and takes immediate corrective action when necessary.

Utilization Management

Evaluate level of care and need for discharge utilizing InterQual. Utilize hospital resources appropriately and in a cost effective manner. Educates and discusses levels of care with physicians.

Contact, collaborate and coordinate with various payers regarding entry to St. Christopher’s. Work closely with payer care manager to ensure optimal outcomes for the patient.

Ensure admission order is constructed correctly on all levels of care placement

Will utilize the Physician Advisor and Director of Case Management Department as a resource when indicated.

Discharge Planning: Assessment and evaluation of the patient needs will be conducted by reviewing current and prior functioning, psychosocial dynamics, and identification of the support system. The discharge plan is developed in collaboration with multi-disciplinary team that may include the payer, external referral companies, physician, patient, and caregiver. The Case Manager will address issues with prior plan of care, specifically concerning readmissions.

Review of insurance benefits

Determine patient needs and resources through interview, multidiscipline, and medical record

Assessment and evaluation will be conducted by reviewing current and prior functioning taking into consideration patient and family healthcare literacy

Discharge planning process includes coordination and collaboration with the patient and Caregiver

Patients and caregivers are always given options for providers and services

Completion of documentation in both AllScripts and the electronic medical record

Associate Standard Behavioral Competencies: Flexibility, stellar work ethic, reliability, professionalism, strong communication skills, resourcefulness, cooperative, team player, good judgement, and technical expertise.

Qualifications: When considering candidates, the director will take into consideration the education level of the RN, experience, and other skills. Disciplines considered are those with active Registered Nurse license

Qualifications: When considering candidates, the director will take into consideration the education level of the RN, experience, and other skills. Disciplines considered are those with active Registered Nurse license.

Experience:

R.N with minimum of three or more years’ acute care clinical nursing recently in a hospital, insurance company or independent review company in utilization. Prefer Pediatric Case Management experience.

Other Skills:

Excellent verbal and written communication skills. Strong organizational and prioritizing skills. Thorough understanding of managed care systems and utilization review criteria.

Knowledge of community resources. Must also be able to manage and perform well under stress