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RN Care Manager
1 week ago
Strive Health Harrisburg, United StatesWhat We Strive For · Strive Health is built for purpose — to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a hig ...
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Care Management Associate
1 day ago
CVS Pharmacy Harrisburg, United StatesThe Care Management Associate is responsible for making outreach calls to providers on behalf of members who may have home infusion needs. Additional responsibilities include but not limited to the following:- Typical office working environment with Management, Associate, Custome ...
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RN Care Manager
3 weeks ago
Strive Health Harrisburg, United StatesWhat We Strive For · Strive Health is built for purpose — to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a hig ...
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Care Manager AIM RN
1 day ago
Empatia Harrisburg, United StatesOur Company: · Empatia is a member of the Gentiva family - an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may ...
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Empatia Harrisburg, United StatesOur Company: · Empatia is a member of the Gentiva family - an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may ...
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Aging Care Manager 2
3 weeks ago
Dauphin County, PA Harrisburg, PA, United StatesThis is a merit hire position. This position is covered by a Collective Bargaining Agreement. The hourly rate is $20.20 per hr. Dauphin County Area Agency on Aging is currently accepting applications for the full-time, day shift position of Aging Care Manager 2 (Weekend Duty-On C ...
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Aging Care Manager 2
1 day ago
Dauphin County Pennsylvania Harrisburg, United StatesJob Description · This is a merit hire position. This position is covered by a Collective Bargaining Agreement. The hourly rate is $20.20 per hr. Dauphin County Area Agency on Aging is currently accepting applications for the full-time, day shift position of Aging Care Manager 2 ...
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Care Manager
1 week ago
UPMC Harrisburg, United StatesIntroducing a great opportunity to work with a cohesive team in a work environment that is both welcoming and supportive.The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge plannin ...
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Care Manager
1 week ago
University of Pittsburgh Medical Center Harrisburg, United StatesThe Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals and authorizations. Works with multi-disciplinary team in resource management, discharge ...
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Palliative Care RN- Advanced Illness Management
3 weeks ago
Empatia West End, United StatesOur Company: Empatia is a member of the Gentiva family - an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may m ...
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oncology rn care manager ii
3 weeks ago
Blue Cross and Blue Shield Association Harrisburg, PA , USA, United StatesPosition Description · At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the Best Places to Work in PA. · The RN Care Manager 2 is responsible ...
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Part Time Care Manager Harrisburg
1 week ago
Crossroads Treatment Centers Harrisburg, United States Part timeCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. · Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat pat ...
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Part Time Care Manager Harrisburg
1 day ago
Crossroads Treatment Centers Harrisburg, United States Part timeCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. · Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat pat ...
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AmeriHealth Caritas Harrisburg, United States**Behavioral Health Care Manager--PerformCare Pennsylvania**Location: Harrisburg, PAPrimary Job Function: Behavioral HealthID**: 34296**Job Brief**PerformCare PA seeking an experienced Behavioral Health Care Manager for a Full-Time opportunity. This is a 100% Remote position but ...
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AmeriHealth Caritas Harrisburg, United StatesBehavioral Health Care Manager--PerformCare Pennsylvania · Location: Harrisburg, PA · Primary Job Function: Behavioral Health · ID**: 34296 · Job Brief · PerformCare PA seeking an experienced Behavioral Health Care Manager for a Full-Time opportunity. This is a 100% Remote positi ...
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Palliative Care RN- Advanced Illness Management
3 weeks ago
Gentiva Harrisburg, United StatesOur Company · Empatia is a member of the Gentiva family - an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may m ...
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Care Management Associate
3 weeks ago
CVS Pharmacy Harrisburg, United StatesThis position is fully remote and employees can work from any state. Normal Working Hours: 5 days a week (may include Saturday) various 8-hour shifts either 11:00 am-7:30 pm EST or 12:30 pm-9:00 pm EST along with 1 to 2 weekend shifts per month (eith Management, Associate, Medica ...
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RN Registered Nurse Care Manager
2 days ago
Penn State Health Camp Hill, United StatesPenn State Health - Holy Spirit Medical Center · Location: US:PA:Camp HIll · Work Type: Full Time · FTE: 1.00 · Shift: Day · Hours: 8 hours · Recruiter Contact: Emilee Barwin at ) · SUMMARY OF POSITION: · Works with physician and multidisciplinary team members to develop plan of ...
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Curo Health Services Harrisburg, United StatesOur Company · Empatia is a member of the Gentiva family - an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may m ...
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Aging Care Manager 2
2 days ago
Dauphin County Pennsylvania Harrisburg, United StatesJob DescriptionThis is a merit hire position. This position is covered by a Collective Bargaining Agreement. The hourly rate is $20.20 per hr. Dauphin County Area Agency on Aging is currently accepting applications for the full-time, day shift position of Aging Care Manager 2 (We ...
Care Manager - Harrisburg, United States - UPMC
Description
The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals and authorizations. Works with multi-disciplinary team in resource management, discharge planning and care facilitation.This position is eligible for a generous sign-on bonus.
Responsibilities:
Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination.
Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.
Collaborates with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge. Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services.Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care.
Documents Freedom of Choice re:
post-acute services.
Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.
Attends Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources.
Ensures compliance with all payer and government regulations.Promotes patient safety. Supports CORE measures information for JCAHO requirements.
Takes leadership role in concurrent denial process.
Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC.
Initiates acceptance of lower LOC when appropriate with assistance from billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.Starts discharge planning on admission and ensures DC documentation is completed and updated regularly.
Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge.
Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge. Documents all Avoidable Days in CANOPY system.Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.) Obtains all necessary authorizations for level of care including admission and continued stay.
Follows payer-specific requirements to obtain and document authorizations.#J-18808-Ljbffr
