Registered Nurse Case Manager

Job DescriptionJob DescriptionRegistered Nurse Case Manager Philadelphia, PA 13 weeks Hours per Week: 40 Schedule: Monday-Friday, 8:00 AM - 4:30 PM Interview Type: In-Person Interview Rounds: 2 Required Qualifications Registered Nurse (RN) required. Minimum of 5 years of relevant experience. Prior inpatient hospital case management experience required. Strong discharge planning experience required. Hospital-based case management experience required; insurance-only case management experience will not be considered. Bachelor's degree required. Strong technical proficiency and comfort navigating healthcare systems and technology platforms. Ability to work independently with minimal onboarding or supervision. Experience managing patient caseloads of approximately 18-25 patients daily. Excellent communication, coordination, and interdisciplinary collaboration skills. Preferred Qualifications Pediatric experience preferred. Home care experience preferred. Previous experience within a large acute-care hospital environment preferred. Additional Requirements Local candidates only. Candidates must be able to work onsite at Main Hospital, PA. Preference for candidates who can begin shortly after offer acceptance and compliance clearance.Duties: Job Summary: The Case Manager provides clinically focused care coordination and transition management services to support safe, efficient, and patient-centered care throughout hospitalization. This role collaborates with patients, families, physicians, social workers, payers, and interdisciplinary team members to facilitate timely progression of care and address barriers to discharge. The Case Manager develops, implements, and evaluates individualized discharge plans to ensure appropriate transitions across the continuum of care. Responsibilities include monitoring patient progress toward discharge goals, communicating payer authorization determinations, and coordinating post-acute services and community resources. The Case Manager utilizes risk stratification tools to identify high-risk patients, reduce delays in care, prevent avoidable readmissions, and promote successful patient outcomes and transitions.  Job Responsibilities: --Care Coordination & Transition Management: -Assesses patients and families for transition of care needs and develops, implements, and evaluates individualized discharge plans in collaboration with the interdisciplinary team. -Initiates discharge planning upon admission and actively manages the progression of the discharge plan throughout the patient's hospitalization. -Reviews and evaluates patient risk scores and identifies patients requiring enhanced care coordination interventions. Patients with a risk score greater than or equal to 5 must have a documented discharge plan established and actively managed throughout the admission. -Conducts formal discharge plan re-evaluations at least every eight (8) business days and more frequently when significant changes in the patient's condition, treatment plan, or discharge needs occur. -Communicates approved days, denied days, authorization status, and payer determinations to the clinical team and other appropriate stakeholders to support care progression and discharge planning activities. -Collaborates with physicians, nursing, social work, rehabilitation services, and other members of the healthcare team to identify and mitigate barriers that may delay discharge. -Uses clinical knowledge and anticipated response to treatment to assess patient progression toward discharge goals and intervenes when progression is delayed or diverted. -Participates and leads in progression of care rounds, complex patient discussions, and huddles to facilitate safe, timely transitions of care. --Patient and Family Engagement: -Collaborates with patients and families to develop patient-centered discharge plans that align with clinical needs, patient preferences, and available community resources. -Ensures Freedom of Choice documentation is completed and appropriately documented for all patients requiring post-hospital services, equipment, placement, or other transitional care needs. -Educates patients and families regarding available post-acute care options and supports informed decision-making related to discharge planning and service selection. --Post-Acute Care Coordination: -Coordinates home care services, durable medical equipment, infusion services, rehabilitation services, skilled nursing placement, and other post-acute resources as appropriate to support safe discharge. -Ensures discharge milestones are established, documented, and maintained for all patients requiring post-hospital services or ongoing care coordination needs. -Assembles and communicates necessary referrals, clinical documentation, discharge summaries, and transition information to receiving providers and agencies prior to discharge. --High-Risk Patient Management: -Identifies high-risk patients through clinical judgment and interdisciplinary referrals and develops targeted interventions to address identified risks. Skills: Required Skills & Experience: -At least five (5) years experience. -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.  Preferred Skills & Experience: -Previous experience with discharge planning or home care experience. OR -Prior experience as a Case Manager or Utilization Reviewer. OR -Previous experience in a pediatric setting or similar adult setting.  Responsibilities Cont'd: -Monitors progress toward discharge milestones and escalates barriers requiring leadership, physician, payer, or interdisciplinary intervention. --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. -Researches, 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. #TB_RN