SHIFT:

Day (United States of America)

This RN position requires 5 years of previous RN work experience. It is Monday to Friday, fully onsite -8-4:30. There is a commitment of approximately one holiday per year and 4-6 weekend shifts annually.

There is a $2500 sign on bonus offered for this position.

Seeking Breakthrough Makers
Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.
At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.


About the Job
The Case Manager provides clinically focused care coordination and transition management services to support safe, efficient, and patient-centered care throughout hospitalization. This role collaborates with patients, families, physicians, social workers, payers, and interdisciplinary team members to facilitate timely progression of care and address barriers to discharge. The Case Manager develops, implements, and evaluates individualized discharge plans to ensure appropriate transitions across the continuum of care. Responsibilities include monitoring patient progress toward discharge goals, communicating payer authorization determinations, and coordinating post-acute services and community resources. The Case Manager utilizes risk stratification tools to identify high-risk patients, reduce delays in care, prevent avoidable readmissions, and promote successful patient outcomes and transitions.

What you will do

• Care Coordination & Transition Management
  • Assesses patients and families for transition of care needs and develops, implements, and evaluates individualized discharge plans in collaboration with the interdisciplinary team.
  • Initiates discharge planning upon admission and actively manages the progression of the discharge plan throughout the patient's hospitalization.
  • Reviews and evaluates patient risk scores and identifies patients requiring enhanced care coordination interventions. Patients with a risk score greater than or equal to 5 must have a documented discharge plan established and actively managed throughout the admission.
  • Conducts formal discharge plan re-evaluations at least every eight (8) business days and more frequently when significant changes in the patient's condition, treatment plan, or discharge needs occur.
  • Communicates approved days, denied days, authorization status, and payer determinations to the clinical team and other appropriate stakeholders to support care progression and discharge planning activities.
  • Collaborates with physicians, nursing, social work, rehabilitation services, and other members of the healthcare team to identify and mitigate barriers that may delay discharge.
  • Uses clinical knowledge and anticipated response to treatment to assess patient progression toward discharge goals and intervenes when progression is delayed or diverted.
  • Participates and leads in progression of care rounds, complex patient discussions, and huddles to facilitate safe, timely transitions of care.
  • Patient and Family Engagement
  • Collaborates with patients and families to develop patient-centered discharge plans that align with clinical needs, patient preferences, and available community resources.
  • Ensures Freedom of Choice documentation is completed and appropriately documented for all patients requiring post-hospital services, equipment, placement, or other transitional care needs.
  • Educates patients and families regarding available post-acute care options and supports informed decision-making related to discharge planning and service selection.
• Patient and Family Engagement
  • Collaborates with patients and families to develop patient-centered discharge plans that align with clinical needs, patient preferences, and available community resources.
  • Ensures Freedom of Choice documentation is completed and appropriately documented for all patients requiring post-hospital services, equipment, placement, or other transitional care needs.
  • Educates patients and families regarding available post-acute care options and supports informed decision-making related to discharge planning and service selection.
• Post-Acute Care Coordination
  • Coordinates home care services, durable medical equipment, infusion services, rehabilitation services, skilled nursing placement, and other post-acute resources as appropriate to support safe discharge.
  • Ensures discharge milestones are established, documented, and maintained for all patients requiring post-hospital services or ongoing care coordination needs.
  • Assembles and communicates necessary referrals, clinical documentation, discharge summaries, and transition information to receiving providers and agencies prior to discharge.
• High-Risk Patient Management
  • Identifies high-risk patients through clinical judgment and interdisciplinary referrals and develops targeted interventions to address identified risks.
  • Monitors progress toward discharge milestones and escalates barriers requiring leadership, physician, payer, or interdisciplinary intervention.
• Other Responsibilities:
  • Adheres to established departmental policies, procedures, and objectives.
  • Enhances professional growth and development by accessing educational programs, job related literature, in-service meetings, and workshops/seminars.
  • Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
  • Maintains established department/hospital/system policies and procedures, directives, safety, environmental and infection control standards appropriate to this position.
  • Demonstrates a courteous and professional manner through interactions with internal and external customers.
  • Integrates scientific principles and research based knowledge in decision making.
  • Exemplifies a professional image in appearance, manner and presentation.
  • Engages in self-performance appraisal, identifying areas of strength as well as areas for professional development.
  • Researches, selects and promotes adaptation of best practice findings to ensure quality patient care and optimal outcomes.
  • Adapts behavior as needed to the specific patient population, including but not limited to: respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style
  • Performs other related duties as assigned.

Licenses and Certifications

• Registered Nurse (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required
• Accredited Case Manager (ACM) - American Case Management Association (ACMA) - upon hire - Preferred
• Certified Case Manager (CCM) - Commision for Case Manager Certification - upon hire - Preferred

Education

• Technical Diploma Nursing Required
• Bachelor's Degree Nursing Preferred

Experience

• At least five (5) years experience. Required
• Previous experience with discharge planning or home care experience Preferred or
• Prior experience as a Case Manager or Utilization Reviewer Preferred or
• Previous experience in a pediatric setting or similar adult setting Preferred

Knowledge, Skills and Abilities

• Excellent communication skills and demonstrated organizational skills. (Required proficiency)
• Ability to work effectively with all departments and all levels of CHOP professionals. (Required proficiency)
• Ability to work independently or within a team structure. (Required proficiency)
• Must be very organized and able to work independently. (Required proficiency)
• Ability to establish priorities among multiple needs, meet deadlines and maintain standards of productivity. (Required proficiency)
• Knowledge of managed care admission process (i.e. verification of benefits, admissions notification). (Required proficiency)
• Ability to effectively negotiate with internal and external providers of patient care services. (Required proficiency)
• Sound problem solving skills. (Required proficiency)
• Excellent customer service orientation and strong interpersonal skills. (Required proficiency)
• Computer skills and a working knowledge of Word, Excel and Access. (Required proficiency)

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.
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SALARY RANGE:

$101,300.00 - $129,100.00 Annually

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.