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RN Case Manager - Canonsburg Hospital (Full Time)

Allegheny Health Network

  • Company AHN
  • Canonsburg, PA - Canonsburg Hospital
  • Nursing
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

Job Description

Date Posted: 20220629
Location: Canonsburg Hospital
Department:  Case Management

Status: Full Time

Inpatient Area's: Daylight, 40 hours per week shift- rotating weekends
Union: Yes


Registered nurse who is proficient in the coordination of care and manages coordination of care in accordance with recognized standards of practice for Care Management. Professional role model utilizing expertise in care management to promote a collaborative professional environment that supports excellence of care and achievement of optimal resource utilization.  Also facilitates appropriate LOS, patient satisfaction and reimbursement for all patients.


  • Assume role in assessment of patient physical, psychosocial and economic needs for effective transition of care planning to a variety of levels of care.
  • In collaboration with the care team, facilitate the development and communication of the continuum of care transition plan to appropriate health service providers.
  • Document, verify and validate specific data required to monitor and evaluate interventions and outcomes.
  • Interview and collect patient specified data and chart review related to readmission.
  • Knowledgeable of and complies with accreditation and regulatory requirements. Integrates performance improvement principles and customer service principles into all aspects of job responsibilities.
  • Obtain or ensure acquisition of appropriate pre-certification authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party guidelines. Obtain or facilitate acquisitions of urgent/emergent authorizations, continued stay authorizations and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements.
  • Document, monitor, intervene/resolve and report clinical denials/appeals and retrospective payer audit denials. Collaboratively formulate plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor and third party payers, etc.
  • Maintain a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serve as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adhere to the policies, procedures, rules, regulations and laws of the hosptial and all federal and state regulatory bodies. Communicate telephonically and electronically with the outpatient providers in an effort to enhance the continuum of care.
  • Assume responsibility for AHN required continued education and own professional growth.
  • Perform other duties as assigned or required.



  • BA/BS degree and nursing diploma required. Current employees grandfathered.
  • Current PA RN license required.
  • Nationally recognized Care Management Certification within 5 years of start date (3 years for currently employed) required.
  • CPR
  • 2 - 3 years of recent clinical RN acute care experience required


  • Discharge planning and community resource knowledge preferred.
  • Care facilitation and utilization review experience preferred.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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