Nursing Jobs in Old City, 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 $104,613 - $167,938 / year
At Virtua Health, we exist for one reason – to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between – we are your partner in health devoted to building a healthier community. If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment. In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 other locations , we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program , telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics. Location: Lourdes Health System - 1600 Haddon Ave Remote Type: On-Site Employment Type: Employee Employment Classification: Regular Time Type: Full time Work Shift: 1st Shift (United States of America) Total Weekly Hours: 40 Additional Locations: Job Information: This is leadership position for Non-Invasive Cardiac Testing. This role will provide operational, clinical, and personnel oversight for the non-invasive cardiac testing program, including support for quality, patient throughput, staffing, scheduling, regulatory compliance, and standardization across the service line. The Nurse Manager will align the Lourdes cardiac testing department with the other 4 acute care testing departments. Position Qualifications Required / Experience Required: Minimum 2 years specialty experience. 2 years Management experience in specialty area preferred. (VMT - Minimum of (2) years' experience in critical care nursing and (2) years' experience in SCTU nursing required, 2 years management experience in specialty area preferred.) Required Education: Graduate of an accredited school of nursing. (MICU-Bachelor’s degree required.) Training/Certifications/Licensure: Appropriate certification per specialty and/or regulatory agency is required. Current New Jersey RN license required. Summary: The Nurse Manager will perform the duties of patient care and management of the daily operations of the department. This person is responsible for efficient operations, scheduling, safety, patient care coordination, quality management, as well as patient, professional, and community education. Ensures effective interdisciplinary team communication and interaction. The Nurse Manager is also responsible for coordinating clinical services and assuring consistent quality care for patients, working within the framework of the State Nurse Practice Act and following all corporate policies and procedures. Position Responsibilities: • Responsible for the ongoing daily management within the scope of the corporate standards, protocols, guidelines, policies and procedures. Works in collaboration with nursing, medical staff, ancillary departments and may include pilots and pre-hospital providers. • Supervise all aspects of care delivered and provide routine performance feedback to staff on a consistent basis. • Responsible for hiring, scheduling, counseling and evaluating staff. Assumes role of staff nurse/paramedic when necessary. • Incorporates research, performance improvement, education and clinical activities to enhance the care of patients. • Actively supports and monitors the corporate Quality Management Program to ensure quality services and outcomes. • Responsible for assuring compliance with all applicable regulatory and governmental agencies (e.g. AAAHC, DOH), including conducting, documenting all necessary educational in-services/competencies and updating policies and procedures. • Actively participates in the formation and implementation of the budget and monitors to remain within financial constraints. Annual Salary: $104,613 - $167,938 The actual salary/rate will vary based on applicant’s experience as well as internal equity and alignment with market data. This position is eligible to participate in one of Virtua’s annual incentive compensation plan (AICP). The amount is subject to the terms and conditions of the plan document. Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions. Eligibility for benefits is governed by the applicable plan documents and policies. For more benefits information click here . 
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