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RN Case Manager (pa2624-ob)

Case Management | Harrisburg, PA | Full Time

Job Description

RN Case Manager

Harrisburg PA

 

We are currently accepting resumes for a qualified Risk Management Specialist to provide services to the Commonwealth of Pennsylvania in Harrisburg PA.   If you meet the requirements below, we encourage you to apply and our staff will reach out to you to discuss this position further and answer any questions.

 

REQUIRED QUALIFICATONS

  • Possess an active Pennsylvania Registered Nurse license
  • CCM (Certified Case Manager) required, administered through CCMC (Commission or Case Management Certification) or the National Academy of Certified Care Managers or American Nurses Credentialing Center; or attain certification after 12 months of continuous employment from the date of hire. Continued employment would be conditional on the candidate obtaining certification within the said time
  • Possess a documented work history of two or more years of experience in case management or a related field
  • Possess basic computer skills, including familiarity with Microsoft Office programs
  • Possess experience of the six (6) essential activities of case management: assessment, planning, implementation, coordination, monitoring, and evaluation follow the Standards of Practice for Case Management as established by the Case Management Society of America (CMSA)
  • Be available as a full-time consultant approximately 37.5 hours per week

 

POSITION ROLE AND RESPONSIBILITY

  • Assess the need for case management intervention by obtaining and objectively evaluating data, including clinical information, medical history, level and location of care, functional status, psychosocial and environmental factors
  • Documents assessment, goals, plan of care and timetable for implementing interventions
  • Facilitates the implementation of the care plan by optimizing available benefit, comparing the benefits and cost of care
  • Plan alternatives based on recipient needs and investigate opportunities to use available community resources
  • Utilize Medical Assistance regulations for prospective review of medically necessary services and procedures
  • Work closely with the PCP, specialists and other providers to support the treatment plan and achievement of goals developed for and by the recipient or caregiver
  • Set expectations for timely reports with the vendors providing services
  • Measure effectiveness, necessity and efficiency of the care plan and make revisions as needed
  • Collaborates with enrolled providers to assure recipients are referred to the appropriate providers to deliver care and services to recipients in a cost-effective manner
  • Educate the recipient, family or significant other, physician and providers relating to the availability of community resources and services
  • Work closely with medical directors to implement appropriate action plans
  • Acts as a resource for others within the company
  • Collaborates with the inpatient review nurses to coordinate discharge planning to an appropriate level of care
  • Effectively manage a caseload of 75-100 cases
  • Maintains management records in accordance with professionally accepted standards
  • Participates in the development of desktop procedures
  • Collaborate with other bureaus/contractors to assure continuity of care
  • Performs other duties as assigned

 

We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.