RN Care Manager - Highmark Wholecare - Remote, PA
(2026-01)
Function as a primary clinician for members with complex health needs with the depth of engagement ranging from basic coaching to intensive case and disease management.
- Help develop and support the member's ability to self-manage and navigate the health care system and to provide members with resources and tools to assist in health-related decision making.
- Conduct telephonic clinical assessments that address the health and wellness needs of the Organization's members using a broad set of clinical and motivational interviewing skills with the goal of effecting members' self-management and positive behavior changes.
- Develop case or condition-specific plans of care using the clinical information system to establish short and long-term goals.
- Communicate with the member's treating provider or providers in more complex clinical situations requiring case management intervention. Also serves as a subject matter expert to clinicians from other HMS teams to provide education, consultation, and training when indicated.
- Identify on-line, telephonic and community-based resources that can assist the member to achieve and maintain their personal health goals and assists the member to access those services.
- Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards
RN Case Manager - St. Luke's Upper Bucks Hospital - Quakertown, PA
(2023-02 - 2026-01)
Responsible for coordinating the care and services for unit-based patient populations as well as those in the Emergency Department.
- Promote quality of care, support effective resource utilization, and facilitate the patient's progression of care to proactively plan for the patient's safe and timely discharge to the most appropriate level of care
- Serves as the key resource for the patient's multi-disciplinary care team, and work collaboratively with all members of the patient's health care team and patient representatives to achieve desired clinical, financial, and quality outcomes
- Analyze current systems and variances to prevent delays and identify opportunities for improvement
- Develops a discharge plan that addresses the psycho-social needs to meet desired goals for the next step in the continuum of care for patients.
- Collaborates with the patient, family or other caregivers, and multidisciplinary team to design a discharge plan respective of the patient's needs and goals.
- Works as a team with other members of care management, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director.
- Facilitates communication among all treatment team members.
- Manages length of stay by proactively identifying and mitigating issues and barriers to care and a successful discharge plan.
- Updates the care team, patient/family as to the status of the discharge plans. Re-evaluates and revises the discharge plan as additional information is acquired.
- Proactively considers options such as palliative care, homecare and other services that work to keep the patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions.
- Issues applicable state/federal regulatory notices as applicable ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), Bundle Payment Care Initiative (BPCI) notification.
- Monitors risk assessment using available tools and implements discharge interventions accordingly.
- Actively addresses and monitors resource utilization and documents delays as appropriate.
- Identifies patients with an unplanned readmission and completes root cause analysis.
- Coordinates utilization of patient and community resources to facilitate achievement of a safe and effective discharge plan and accomplishment of goals as well as minimizing risk of readmission.
- Collaborates with Outpatient Care Managers to identify patients for handover and post discharge follow up.
- Provides supportive counseling and advocacy to assist patients and/or family with adjustment associated with illness, hospitalization and/or alternative care placement. Facilitates the decision-making process in complex cases.
- Facilitates resolution of issues surrounding patient care in a compassionate manner, utilizing team meetings as appropriate.
- Act as resource to the staff for regulatory issues regarding discharge-planning and psychosocial processes.
- Uses electronic systems to accurately document care manager functions.
RN Case Manager - Tower Health Pottstown Hospital - Pottstown, PA
(2021-01 - 2023-02)
Responsible for coordinating the care and services for unit-based patient populations as well as those in the Emergency Department.
- Perform initial utilization review of medical necessity for admitting patients
- Promote quality of care, support effective resource utilization, and facilitate the patient's progression of care to proactively plan for the patient's safe and timely discharge to the most appropriate level of care
- Serves as the key resource for the patient's multi-disciplinary care team, and work collaboratively with all members of the patient's health care team and patient representatives to achieve desired clinical, financial, and quality outcomes
- Analyze current systems and variances to prevent delays and identify opportunities for improvement
Hospice RN Case Manager - Tower Health at Home Hospice - Wyomissing, PA
(2020-05 - 2021-01)
- Independent development and implementation of plans of end-of-life care
- Management of bio-psycho-social-spiritual needs of patients and their families
- Educate families on medications and patient care at end of life
- Coordination of care with an interdisciplinary team including, but not limited to RN case managers, hospice managers, social workers, chaplains, doctors and home health aides
- Direct clinical hands-on care provided, including wound care, port, PICC, midline and foley catheter care/maintenance, physical assessments and monitoring/treatment of symptoms
- Timely documentation of patient care in EMR systems (McKesson, EPIC)
- Trusted advisor to peers and senior medical staff
- As a MSW, I have an awareness of social indicators and barriers to health care and can recommend resources and actions that the patient and their families can employ
Hospice RN Case Manager - Heartland Hospice - Wyomissing, PA
(2019-01 - 2020-05)
- Managed physical, mental, emotional, and spiritual needs of patients and families through end-of-life issues
- Communicated daily with interdisciplinary team members including physicians, social worker, chaplain, nursing assistants, volunteer coordinator, and other hospice nurses
- Developed and implemented individualized plan of cares via computerized documentation
- Utilized critical thinking, communication, time management, and problem-solving skills
- Performed various clinical duties like complete physical assessments, monitoring vital signs, and wound assessment and treatment for critically ill patients
RN - Tower Health Pottstown Hospital - Pottstown, PA
(2018-02 - 2018-12)
- Able to monitor cardiac patients through telemetry
- Understand and apply CVA/TIA protocol
- Provide direct and indirect patient care utilizing the nursing process
- Perform admissions, patient education, and documentation thoroughly
- Work collaboratively with other healthcare professionals to treat patients
