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Part Time Rn Case Review Jobs in Pennsylvania (NOW HIRING)

Kadima at Luzerne

Registered Nurse

Drums, PA

If you're a motivated and compassionate Registered Nurse looking for a rewarding opportunity, we encourage you to apply to this Part Time Registered Nurse position. Join our team and become a part of ...

BAYADA Home Health Care

Registered Nurse

York, PA

We have a Full Time or Part Time Registered Nurse opportunity open now doing Home Health Visits for ... Case management and coordination * Accurately document observations, interventions, and evaluations ...

Manatawny Manor

RN Supervisor (Nights)

Pottstown, PA

Seeking a Part Time RNs for Night Shift! Manatawny Manor is now hiring an RN Supervisor for our Night Shift (Part Time) who is committed to providing the best life and care for our residents. If you ...

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Part Time Rn Case Review information

How to make an extra $2000 a month as a nurse?

Part-time RNs can increase their income by taking on additional shifts, working in high-demand specialties, or providing telehealth services. Gaining certifications in areas like case review or case management can also open opportunities for higher-paying freelance or consulting roles outside regular hours.

How to make $150,000 as a nurse?

A part-time RN case review nurse can increase earnings by gaining specialized certifications, such as in case management or coding, and working in high-demand settings like insurance companies or telehealth. Combining multiple part-time roles, maintaining strong clinical skills, and working flexible hours can also help reach higher income levels, though earning $150,000 part-time may require additional certifications or experience.

Are RN case managers in demand?

RN case managers are in high demand due to the growing need for care coordination, patient advocacy, and healthcare management across hospitals, insurance companies, and community health organizations. Their skills in clinical assessment, documentation, and care planning are essential in improving patient outcomes and reducing healthcare costs.

What is the difference between Part Time Rn Case Review vs Part Time Rn Utilization Review?

AspectPart Time Rn Case ReviewPart Time Rn Utilization Review
CredentialsRegistered Nurse (RN) licenseRegistered Nurse (RN) license
Work EnvironmentHospitals, clinics, insurance companiesInsurance companies, healthcare organizations
Job FocusReview patient cases for appropriateness of careAssess medical necessity and insurance coverage
Common UsageCase review, patient care evaluationUtilization management, insurance review

Both roles require RN licensure and involve reviewing healthcare cases. However, Part Time Rn Case Review primarily focuses on evaluating patient cases for quality of care, while Part Time Rn Utilization Review emphasizes assessing medical necessity for insurance purposes. Understanding these distinctions helps professionals choose the role that best fits their skills and career goals.

How to become a nurse reviewer?

To become a nurse reviewer, typically a registered nurse (RN) must have several years of clinical experience, often in case management or review settings. Additional qualifications may include certification in case management or utilization review, strong analytical skills, and familiarity with healthcare documentation and coding systems.
What are the most commonly searched types of Rn Case Review jobs in Pennsylvania? The most popular types of Rn Case Review jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Part Time Rn Case Review jobs? Cities in Pennsylvania with the most Part Time Rn Case Review job openings:
Part Time Rn Case Review jobs near you
RN Case Manager (Part Time) - Forbes Hospital

RN Case Manager (Part Time) - Forbes Hospital

Highmark Health

Monroeville, PA • On-site

Part-time

Posted 5 hours ago

Highmark Health rating

7.8

Company rating: 7.8 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

Job description

Company :
Allegheny Health NetworkJob Description :
GENERAL OVERVIEW:
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.
ESSENTIAL RESPONSIBILITIES:
  • Assumes 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, facilitates the development and communication of the continuum of care transition plan to appropriate health service providers.
  • Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes. Interviews and collects 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.
  • Obtains or ensures 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. Obtains or facilitates 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.
  • Documents, monitors, intervenes/resolves and reports clinical denials/appeals and retrospective payer audit denials. Collaboratively formulates plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor and third party payers.
  • Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to the policies, procedures, rules, regulations and laws of the hospital and all federal and state regulatory bodies. Communicates telephonically and electronically with the outpatient providers in an effort to enhance the continuum of care.
  • Assumes responsibility for AHN required continued education and own professional growth.
  • Performs other duties as assigned or required.

QUALIFICATIONS:
Minimum
  • Bachelor's Degree in Nursing -OR- Bachelor's Degree and Nursing Diploma -OR- 6 years of relevant experience in lieu of a degree
  • 3 years in a clinical nursing role
  • Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
  • Professional Certification within 5 years of start date. Incumbents in role as of 12/1/2022 have until 12/31/2026 to obtain
  • Critical thinking and problem solving
  • Flexibility and adaptability to change
  • Strong communication and collaboration skills with ability to tailor style according to target audience (providers, peers, clinical team members, patients, families)
  • CPR - American Heart Association
  • Act 34 Criminal Background Clearance Certificate
  • Act 33 Child Abuse Clearance Certificate
  • Act 73 FBI Fingerprinting Criminal Background Clearance Certificate

Preferred
  • Nationally recognized Case Management Certification
  • Transition planning and understanding of community and facility resources
  • Knowledge of motivational interviewing techniques
  • BSN

LICENSES or CERTIFICATIONS
Required
  • None

Preferred
  • ACM Certification (Accredited Case Manager) - American Case Management Association - American Case Management Association
  • Case Management - American Board of Occupational Health Nurses (ABOHN) and
    Certified Case Manager (CCM)
  • Commission for Case Manager Certification (CCMC)

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
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 any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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About Highmark Health

Sourced by ZipRecruiter

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2022 consolidated revenues totaling $26 billion. And we're proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

Industry

Health care and social assistance and insurance services

Company size

10,000+ Employees

Headquarters location

Pittsburgh, PA, US

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