Registered Nurse (RN) - Case Manager

Registered Nurse (RN) - Case Manager 
Job Type:  PRN| M-Sun 8a-430p

Your experience matters 

Conemaugh Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Social Worker joining our team, you’re embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

More about our team 

The Utilization Management RN Case Manager (UM-RNCM) works under the direction of the Case Management Manager and plays a critical role in ensuring accurate clinical documentation and regulatory compliance. The UM-RNCM performs initial clinical reviews of assigned patient records to validate Severity of Illness and Intensity of Service using industry-standard criteria (MCG). Cases that do not meet criteria are escalated to Physician Advisors, with ongoing follow-up to ensure appropriate utilization and compliance. This role is responsible for communicating clinical information to managed care organizations to secure authorization for services and reimbursement. The UM-RNCM also ensures accurate patient status throughout the hospital stay and collaborates closely with physicians to address and resolve any denial determinations.

How you’ll contribute 

A Registered Nurse (RN) Case Manager who excels in this role:

• Skilled in Case Management functions and Care Coordination

• Utilizes Interqual or the 2MN rule to determine status for all patients assigned an acute care bed. 

• Reviews medical records and provides accurate clinical information to payers for authorization.

• Collaborate with interdisciplinary team to facilitate progression of care and resource utilization. 

• Proactively interacts with patients and families during the admission process to set expectations for the course of stay and length of stay.

• Proactively analyzes information from the care team to support inpatient admission.

• Assesses, identifies, and intervenes to reduce the risk of barriers that will interfere with the transition of care. 

• Facilitates optimal care transition to reduce avoidable readmissions.

• Follows the Case Management policy & procedure for utilizing Physician Advisors.

• Interacts with attending physicians, physician advisor and department chairs about any identified quality issues and utilization issues.

• Leads Interdisciplinary Discharge Planning Rounds (IDTs) to determine appropriate concurrent care planning, resource utilization and appropriate post acute level of care determination. 

• Identifies and documents avoidable days and intervenes promptly to remove identified barriers.
• Follows CMS & regulatory requirements for Case Management processes.  
• Coordinates concurrent denial/appeal- (peer to peer) process for assigned cases.
• Assumes on-call and weekend duties as assigned.  
•  Assist floor(s) with transportation barriers during working hours. 

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: 

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.

• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.

• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.

• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and