Nursing Jobs in Glenside, PA
$75,000 - $115,000 / hour
Case Manager – HMO Skilled Nursing Focus Location: Eddystone, Pennsylvania Salary Range: $75,000 – $115,000 annually Position Summary We are seeking an experienced and detail-oriented Case Manager to support members within a Skilled Nursing Facility (SNF) and managed care/HMO environment. This role is responsible for coordinating patient care services, managing utilization review activities, and serving as a liaison between providers, facilities, and insurance payers to secure timely authorizations and reimbursement. The ideal candidate will have strong knowledge of post-acute care, utilization management, insurance authorization processes, appeals and denial management, and interdisciplinary care coordination. Candidates may hold credentials as an LPN, RN, Master Social Worker (MSW), or Licensed Social Worker (LSW/LCSW), depending on state requirements and organizational needs. Key Responsibilities Manage and coordinate care for members/residents in skilled nursing and post-acute care settings. Perform utilization management and concurrent review to ensure appropriate level of care and length of stay. Obtain and track insurance authorizations for admissions, continued stays, therapies, specialty services, and transitions of care. Communicate with HMOs, Medicare Advantage plans, commercial insurers, and other payers regarding clinical updates and authorization requirements. Prepare, submit, and monitor appeals for denied or reduced services, including writing clinical justifications and gathering supporting documentation. Review denial trends and collaborate with facility leadership to improve reimbursement outcomes and reduce avoidable denials. Coordinate interdisciplinary care planning with nursing, therapy, social services, physicians, and discharge planning teams. Facilitate safe and timely transitions of care, including discharge planning and community resource coordination. Maintain accurate and timely documentation in accordance with regulatory, payer, and organizational requirements. Ensure compliance with Medicare, Medicaid, managed care, and facility policies and procedures. Educate residents, families, and staff regarding insurance coverage, benefits, care planning, and discharge options. Participate in quality improvement initiatives related to utilization review, readmission reduction, and payer performance metrics. Qualifications Required Current and active licensure/certification in one of the following: Licensed Practical Nurse (LPN) Registered Nurse (RN) Master Social Worker (MSW) Licensed Social Worker (LSW/LCSW), depending on state requirements Minimum of 2 years of experience in case management, utilization review, managed care, skilled nursing, or post-acute care. Experience working with Medicare, Medicaid, Medicare Advantage, and commercial insurance plans. Strong understanding of authorization processes, payer guidelines, appeals, and denial management. Excellent communication, organizational, and documentation skills. Ability to manage multiple cases and deadlines in a fast-paced healthcare environment. Preferred Certification in Case Management (CCM, ACM, or equivalent). Experience in SNF reimbursement and PDPM. Familiarity with electronic medical records (EMR/EHR) systems. Knowledge of state and federal regulatory requirements for skilled nursing facilities. Skills & Competencies Utilization Management Insurance Authorization & Verification Appeals & Denial Resolution Care Coordination Discharge Planning Managed Care/HMO Processes Clinical Documentation Review Interdisciplinary Collaboration Critical Thinking & Problem Solving Time Management & Organization Work Environment Skilled Nursing Facility (SNF), post-acute care, managed care organization, or hybrid setting. May require communication with external insurance representatives, hospitals, providers, and family members throughout the day. Equal Opportunity Statement We are an equal opportunity employer and is committed to creating an inclusive environment for all employees. INDCONF3 
$104,474 - $136,557 / year
Req #: 0000242449 Category: Nurses Status: Full-Time Shift: Day Facility: Barnabas Health Medical Group Department: AdvancedHeartFailureSpecial Pay Range: $104,474.00 - $136,557.00 per year Location: Hamilton, Hamilton, NJ 08610 Job Title: Coordinator RN Location: Barnabas Health Medical Group Department Name: AdvancedHeartFailureSpecial Req #: 0000242449 Status: Salaried Shift: Day Pay Range: $104,474.00 - $136,557.00 per year Pay Transparency The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience. Job Overview An RN Coordinator job involves overseeing patient care, acting as a liaison between patients, families, and providers, developing care plans, coordinating services (like home health, specialists), managing staff/operations in a unit, ensuring documentation is accurate, and focusing on transitions of care to improve outcomes, often for chronic conditions like diabetes or CHF, preventing readmissions. Key duties include patient assessment, education, care plan implementation, team communication, and administrative tasks like policy development or scheduling, Qualifications Required: Registered Nurse with a minimum of 3 years of clinical experience Strong organizational and care coordination skills Ability to manage multiple priorities and work collaboratively with interdisciplinary teams Preferred Prior experience in care coordination or case management Experience with grant coordination or program administration Heart failure experince Certifications And Licenses Required (if Applicable—remove When Posting) Active Registered Nurse (RN) License Scheduling Requirements (non-exempt Positions—remove When Posting) Full-Time, Day Shift (40 hours per week) Essential Functions Systematically assess patient needs, develop and implement comprehensive, individualized care plans, and set goals with the patient Link patients to necessary resources, coordinate between different departments, specialists, and post-acute care (home health, hospice) Serve as the primary communicator between patients, families, physicians, and the interdisciplinary healthcare team Educate patients and families about conditions, treatments, and self-management strategies Track patient progress, evaluate care plan effectiveness, and ensure quality and safety standards are met Maintain accurate, up-to-date records of assessments, interventions, and outcomes Supervise nursing staff, manage scheduling, orient new hires, and provide performance feedback (in supervisory roles) Oversee daily unit operations, develop policies, and manage resource allocation Facilitate smooth transitions from hospital to home, identifying barriers and arranging services Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Benefits And Perks At RWJBarnabas Health, our employees are at the heart of everything we do. Driven by our Total Wellbeing promise, our market-competitive offerings include comprehensive benefits and resources to support our employees’ physical, emotional, financial, personal, career, and community wellbeing. These benefits and resources include, but are not limited to: Paid Time Off including Vacation, Holidays, and Sick Time Retirement Plans Medical and Prescription Drug Insurance Dental and Vision Insurance Disability and Life Insurance Paid Parental Leave Tuition Reimbursement Student Loan Planning Support Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Community and Volunteer Opportunities Discounts Through our Partners such as NJ Devils, NJ PAC, and Verizon ….and more! Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health. Paid Time Off (PTO) Medical and Prescription Drug Insurance Dental and Vision Insurance Retirement Plans Short & Long Term Disability Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more! RWJBarnabas Health is an Equal Opportunity Employer 
