Specialty Case Manager - NICU/Pediatric RN

Job Description:
The Specialty Case Manager is a registered nurse sustaining the catalytic force in managing the continuum of care for all patients. This process ensures that all health care resources are used efficiently and effectively. The Specialty Case Manager works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a care plan that will ensure quality medical care for the high risk member population serviced by ProgenyHealth Inc. based on national standards for case management practice.
The Specialty Pediatric Case Manager will focus on empowering the family to support optimal wellness while advocating for the necessary medical services across the health care continuum. He/she will demonstrate strengths in working independently as well as collaboratively within a team environment. An understanding of ProgenyHealth goals and outcome measures is important to the accountability of the Case Manager and the success of the member focused Specialty Care Management Programs.
ProgenyHealth currently has several openings for Full-Time and Part-Time candidates.

Job Duties:
• Introductory calls to families to provide them with an overview of our services
• Complete needs assessments for all infants in case management and develop care plans individualized to the needs of each infant and their family.
• Stratification of infant’s based on their needs and frequent calls to continue to assess and assist with care planning needs.
• Interface with the infant’s PCP and providers to assist with care coordination activities which can include appointments, transportation, DME items etc.
• Provides ongoing case management services to assist families after discharge as the primary contact to assist with care coordination needs throughout the first year of life.

We offer: competitive pay, generous benefits and a pleasant work environment.

Requirements
Skill requirements:
• Registered Nurse (RN) with a current, unrestricted license is required.
• Five or more years of clinical experience as a NICU/pediatric nurse preferred.
• Two or more years of managed care experience in a hospital, integrated health system or health plan in a concurrent review and discharge planning role is preferred.
• Data entry skills required. Must be computer literate.
• Case management/managed care experience is a plus.
• Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks.
• Must demonstrate accuracy in spelling and documentation. Proficiency in a second language is highly desirable.

Interpersonal skills:
Ability to perform job functions with autonomy and be a self starter. Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times. Must have commitment to excellence in customer service.

To Apply:  Please send resume AND salary history to HR Department, ProgenyHealth, via email: jobs@progenyhealth.com or fax: 610-832-2010.

ProgenyHealth is an Equal Opportunity Employer.

Clinical Care Nurse – NICU/Pediatric RN

Job Description:
The clinical care nurse is a registered nurse sustaining the catalytic force in managing the continuum of care for all members. This process ensures that all resources are used efficiently and effectively from pre-admission, continued stay (concurrent review), discharge planning and post-hospitalization care. Clinical care nurses coordinate overall member care, utilizing the principle of Continuous Quality Improvement as stated in our company mission statement. The clinical care nurse serves as a hospital nurse reviewer for admissions, lengths of stay and a facilitator for discharge planning. The clinical care nurse is responsible for the implementation of managed care policies and must be very knowledgeable about the criteria and guidelines used for reviews. Must be adept at identifying and referring potential quality of care issues.
ProgenyHealth currently has openings for Full-Time and Part-Time candidates.

Job Duties:
Performs day to day concurrent review, prior authorization and retrospective reviews of patient care, utilizing established InterQual criteria for SI/IS, ProgenyHealth clinical guidelines, appropriateness for care and setting, discharge criteria and quality indicators. Reviews will be mostly telephonic reviews at in network and out of network facilities. May need to perform on site review for selected cases if required by client’s contracts.

• Provides a service to the facilities’ customers, (member and physicians), by organizing a continuum of care. Acts as a member advocate by the appropriate selection of services, appropriate utilization of resources and providing an ongoing evaluation of patient outcomes. Works closely with physicians and other health care team members to ensure the best possible patient outcome from pre-admission through and including lower level of care services.
• In collaboration with the medical staff, nursing management, and support services, continually evaluates the effectiveness of medical, nursing, or ancillary interventions. When indicated assist in the adjustment of the plan of care to provide efficient and quality patient outcomes. Proactively works with hospital staff and physicians to encourage efficient and timely inpatient utilization.
• Develop a working rapport with all in-house and referral physicians as a competent, knowledgeable source of information for managed care contracts and clinical guidelines, particularly criteria for hospital admissions and length of stay by diagnosis.
• Initiates the continuum of care process for all types of admissions when referred through:
• Screening for discharge planning needs and social service interventions.
• Coordinates selection of anticipated discharge setting.
• Coordinates education interventions as needed.
• Introducing ProgenyHealth’s Case Management Program to families with a prolonged hospital stay and coordinates the mailing of the introductory packet to these families.

We offer: competitive pay, generous benefits and a pleasant work environment.

Requirements:
• Registered Nurse (RN) with a current, unrestricted license is required.
• Five or more years of clinical experience as a NICU/pediatric nurse preferred.
• Two or more years of managed care experience in a hospital, integrated health system or health plan in a concurrent review and discharge planning role is preferred.
• Data entry skills required. Must be computer literate.
• Case management/managed care experience is a plus.
• Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks.
• Must demonstrate accuracy in spelling and documentation. Proficiency in a second language is highly desirable.

Interpersonal skills:
Ability to perform job functions with autonomy and be a self starter. Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times. Must have commitment to excellence in customer service.

To Apply:  Please send resume AND salary history to HR Department, ProgenyHealth, via email: jobs@progenyhealth.com or fax: 610-832-2010.

ProgenyHealth is an Equal Opportunity Employer.