Date Posted: 20200722
Location: Allegheny General Hospital
Department: Care Manager/Utilization Review
Status: Full Time
Shift: 80 hours every two weeks
Daylight, 40 hours per week shift- rotating weekends (typically every 4th to 6th weekend) and Holidays (typically 1 year based on seniority)
The Allegheny Health Network is comprised of eight hospitals: Allegheny General, Allegheny Valley, Canonsburg, Forbes, Jefferson, Saint Vincent, Westfield Memorial and West Penn; and more than 200 primary- and specialty-care practices. And we have approximately 1,700 physicians in every clinical specialty, 17,000 employees and 2,000 volunteers. Together, we provide world-class medicine to patients in our communities, across the country and around the world.
For decades, the hospitals of Allegheny Health Network have been providing people with exceptional healthcare, care that helps people to live healthy lives and care that we deliver throughout their lifetimes.
Since 1885, Allegheny General Hospital (AGH) has offered medical care to Pittsburgh and its surrounding areas. What started with just 50 beds inside two adjoining brick homes has evolved into a premier health care institution with over 600 beds. Today, AGH still follows the founding partners mission statement, “Erected for the benefit of mankind to save life, relieve suffering and conserve health” by continually striving for outstanding patient experience and care. Allegheny General offers its patients many modern-day amenities, state-of-the art surgical suites, innovative technology, and advanced medical treatments, which are delivered by its world-renowned doctors in conjunction with exceptional teams of nurses, technicians, clinicians and supporting staff.
Responsible and accountable for facilitating the provision of quality and cost-effective care delivery for a designated patient population during an acute episode of care. Ensures optimal care management, patient outcomes and reimbursement based upon enactment of the nursing process.
- Coordinates the clinical care with the patient, family, physician(s), and other members of the interdisciplinary team.
- Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients.
- Develops and implements an effective discharge plan while incorporating input from the patient, family, physician(s), and other members of the interdisciplinary team.
- Identifies, analyzes, collects, and communicates data relative to quality and cost issues related to the assigned patient population.
- Expands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues.
- Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies.
- BS/BA Degree Required.
- Current license to practice professional nursing required.
- Current CPR certification required.
- Inpatient clinical nursing experience in an acute hospital setting with two (2) years experience in the population to which the individual is to be assigned required or 2 years relevant CM/UM experience in another healthcare setting.
- Requires interpersonal, analytic, and critical thinking skills for problem solving and decision making, broad and intimate knowledge of reimbursement and regulatory requirements, decisive judgment and the ability to work with minimal supervision.
- Must be able to work in a fast-paced environment requiring adaptability, flexibility and independence while demonstrating high professional standards, leadership, and team membership skills.
- Case Management certification preferred.