Registered Nurse (RN) - Case Management
Heritage Valley Beaver
Beaver, PA

Nurse Case Manager

Department: Case Management Work Hours: Full Time. 8 hours per day, 40 hours per week daylight shift with weekend and holiday rotation coverage This position is chiefly responsible for 1)Utilization Management functions to include working with physicians to determine the medical necessity and appropriate status for inpatient and observation using InterQual criteria, insurance authorizations, denials, peer to peer appeals, and coordinating health care resource utilization across the continuum of care to include managing length of stay to expected 2) Discharge Planning functions to include assessing, developing and implementing appropriate transition of care plans for post-hospital care which safely meet the patient's needs, minimizes 30 day readmissions and maximizes covered benefit entitlements. Requirements Registered Nurse with a current Pennsylvania license and Bachelor's Degree in Nursing or related field; or equivalent combination of education and experience. Minimum of five years acute care experience in Critical Care or Adult Med/Surg. Knowledge of Pathophysiology and Disease Process.; Requires current recent experience in case management, utilization management, and discharge planning,; including knowledge of InterQual criteria. Advanced computer skills.; Successful completion of Acts 73 and/or 169 clearances within 90 days of commencing employment, if applicable. Preferred: Masters Degree; Case Management Certification * In the absence of qualified candidates in the above referenced areas, will consider applicants with Graduate of an accredited professional school of nursing, current Pennsylvania licensure, other state licensure as required. Basic Cardiac Life Support. Applicable training and orientation will be provided.