TravelNurseSource is working with Revolution Healthcare Services to find a qualified Case Manager RN in Philadelphia, Pennsylvania, 19104!
Position Overview: Registered Nurse (RN) Case Manager
Location: Philadelphia, PA 19104
Schedule: Monday – Friday | 8:00 AM – 4:30 PM (40 hours/week)
Work Model: 100% Onsite (Local candidates only)
Interview Process: 2 Rounds (In-Person)
Employment Type: Full-Time / Contract (Possibility of conversion to FTE)
Experience: Minimum of five (5) years of relevant nursing experience.
Job Summary
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. Utilizing risk stratification tools, the Case Manager works to identify high-risk patients, reduce delays in care, prevent avoidable readmissions, and promote successful patient outcomes and care transitions.
Key Responsibilities
Care Coordination & Transition Management
Assess patients and families for transition-of-care needs; develop, implement, and evaluate individualized discharge plans in collaboration with the interdisciplinary team.
Initiate discharge planning upon admission and actively manage the progression of the discharge plan throughout the patient's hospitalization.
Review and evaluate patient risk scores to identify individuals requiring enhanced care coordination interventions. Ensure patients with a risk score ≥5 have a documented discharge plan established and actively managed.
Conduct formal discharge plan re-evaluations at least every eight (8) business days, or more frequently when significant changes occur in the patient's condition, treatment plan, or discharge needs.
Communicate approved days, denied days, authorization status, and payer determinations to the clinical team and appropriate stakeholders to support care progression.
Collaborate with physicians, nursing, social work, rehabilitation services, and interdisciplinary team members to identify and mitigate discharge barriers.
Lead and participate in progression of care rounds, complex patient discussions, and huddles to facilitate safe, timely transitions of care.
Monitor progress toward discharge milestones and escalate barriers requiring leadership, physician, payer, or interdisciplinary intervention.
Patient & Family Engagement
Collaborate with patients and families to develop patient-centered discharge plans aligning with clinical needs, patient preferences, and available community resources.
Ensure Freedom of Choice documentation is properly completed for all patients requiring post-hospital services, equipment, placement, or transitional care needs.
Educate patients and families on available post-acute care options to support informed decision-making regarding discharge planning and service selection.
Post-Acute Care Coordination
Coordinate home care services, durable medical equipment (DME), infusion services, rehabilitation, skilled nursing placement, and other post-acute resources.
Establish, document, and maintain discharge milestones for all patients requiring post-hospital services or ongoing care coordination.
Assemble and transmit necessary referrals, clinical documentation, discharge summaries, and transition information to receiving providers and agencies prior to discharge.
High-Risk Patient & Quality Management
Identify high-risk patients through clinical judgment and interdisciplinary referrals, developing targeted interventions to address identified risks.
Research, select, and promote the adaptation of evidence-based best practices to ensure quality patient care and optimal outcomes.
Integrate scientific principles and research-based knowledge into clinical decision-making.
Professional & Departmental Standards
Adhere to established department, hospital, and health system policies, procedures, directives, and safety/infection control standards.
Maintain professional growth and development by attending educational programs, workshops, in-service meetings, and reviewing current literature.
Demonstrate a courteous, professional manner through all interactions with internal and external healthcare team members.
Adapt communication and behavior appropriately to specific patient populations, maintaining respect for privacy and personal preferences.
Perform other related duties as assigned.
Required Qualifications
Education: Technical Diploma in Nursing required; Bachelor’s Degree in Nursing (BSN) required.
Licensure: Active Registered Nurse (RN) license in the Commonwealth of Pennsylvania upon hire.
Experience: Minimum of five (5) years of relevant nursing experience.
Case Management Focus: Strong prior inpatient hospital-based case management experience and discharge planning experience required (Insurance-only case management experience will not be considered).
Caseload Management: Proven experience managing a daily patient caseload of approximately 18–25 patients.
Technical Skills: Strong technical proficiency and comfort navigating healthcare systems, electronic health records (EHR), technology platforms, and Microsoft Office Suite (Word, Excel, Access).
Work Style: Demonstrated ability to work independently with minimal onboarding or supervision, establish priorities among multiple competing needs, and meet productivity deadlines.
Preferred Qualifications
Certifications:
Accredited Case Manager (ACM) – American Case Management Association (ACMA)
Certified Case Manager (CCM) – Commission for Case Manager Certification
Clinical Background: Previous experience in a pediatric setting (or similar adult setting), acute-care hospital environment, home care, or utilization review.
Core Competencies & Skills
Organizational Excellence: Ability to manage tight deadlines, prioritize complex patient needs, and maintain high operational productivity.
Payer & Utilization Knowledge: Working knowledge of the managed care admission process, including benefit verification and admission notifications.
Negotiation & Problem-Solving: Strong problem-solving abilities with experience negotiating effectively with internal and external providers.
Interpersonal & Communication: Exceptional verbal and written communication skills with a customer-service-oriented approach to collaborating across multidisciplinary leadership and clinical staff.