Nurse Case Manager/CRC at Penn Medicine

Description Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?Summary:Monitors appropriate use of internal resources, communication with interdisciplinary care team and Physician Advisor, with timely coordination of home care, DME, placements, hospice, community resources, transportation, and quality data collection and risk management referral.

Responsibilities:Utilization management activities: monitor appropriate use of internal resources, communication with interdisciplinary care team and Physician Advisor

Discharge planning activities: timely coordination of home care, DME, placements, hospice, community resources, transportation

Quality data collection and risk management referral

Works with patient and family to assure provision of choice in post hospital setting

Educates patient / customers regarding scope and limitations of health care / insurance benefits

Respects each patient’s / customer’s personal dignity, right to privacy and confidentiality

Communicates expected discharge time frame

Keeps current with new providers, new technologies and treatment modalities, and new resources using internet and other sources

Recognizes and provides care based on the unique chronological issues and needs of the older adult.

Interacts with the patient and family in a developmentally appropriate manner.

Discharge Planning:

Completes timely and detailed assessment of patient and family social, emotional and/or discharge needs and health care benefits

Develops and facilitates specific plan to address problems and/or concerns identified by patients, families and health care team

Identifies and consistently documents delays; elevates issues appropriately

Effectively communicates discharge plan with patients, families and health care team

Documents ongoing assessments and plan of care in patient record (Canopy)

Successfully assists patient in moving to the next level of care with transfers to home, agencies, and facilities and with referral to appropriate community resources

Participates and drives accountability in daily interdisciplinary meetings

Utilization Management:

Adheres to guidelines to satisfy 3rd party payer requirements

Educates team in appropriate documentation to reflect Intensity of service (IS) / Severity of Illness (SI) and plan of care

Proactively addresses level of care issues to ensure appropriate care settings and timely patient flow; elevates issues appropriately

Enters all review activity in Canopy concurrently

Accounts for all patient days accurately in Canopy

Enters review indicating “pending” status of case if outcome not determined and accounts for all cases assigned on a daily basis

Collects and submits data as indicated

Completes readmission screen as indicated

Quality Improvement and Risk Management:

Collects and submits data as indicated

Communicates with service line / clinical effectiveness team members

Identifies and appropriately communicates risk management issues

Works with department leadership to develop and implement solutions to issues identified by the Case Management and Social Work Department

New Technology / Computer Systems:

Keeps current with new systems (MedView, On Base, SafetyNet, Sunrise, etc.)

Incorporates technology into daily assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet)

Credentials:Registered Nurse - PA (Required)

PA RN Licensure required.

Education or Equivalent Experience:Bachelor of Arts or Science (Required)

Bachelor's Degree in Nursing required. 2+ years Clinical Experience preferred.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.Live Your Life's WorkWe are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law. REQNUMBER: UPHS-INFOR-109473