Care Manager Nurse

WellSpan Health; Ephrata (Lancaster County); On-site; USD 65,000 - 85,000; Full time

Job summary

WellSpan Ephrata Community Hospital is seeking a PRN Care Manager to support care coordination in the Emergency Department and in-house units, with weekend and holiday rotations required. The role emphasizes utilization and discharge planning to ensure cost-effective, high-quality patient care.

The successful candidate will have RN licensure, a minimum of an associate degree, and at least two years of acute care experience, with preferred experience in care management and ED/critical care

Qualifications

• Associate's degree required.
• 2 years recent acute care experience required.
• Utilization management, care management, or clinical nursing specialty preferred.
• Previous experience in care management, discharge planning, or ED/critical care/trauma/step-down units, medical/surgical/geriatrics strongly preferred.

Responsibilities

• Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
• Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
• Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
• Assists the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost.
• Identifies conditions which require care management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
• Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
• Assists with the collection and analysis of utilization patterns and denied cases.
• Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).
• Prepares and maintains appropriate documentation as required.
• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Skills

Acute care experience

Utilization management

Care management

Discharge planning

Education

Associate's degree

Job description

• Locations 169 Martin Ave, Ephrata, PA, 17522, US
• FTE 0.001

Job Description

PRN Care Manager Position

8:30am to 9:00pm

Shifts primarily covering the Emergency Departments but also flexing to in house units based upon department needs

Weekend and holiday rotations required

Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred

General Summary

Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Works in a team type assignment or Care Coordination Team (CCT) Model (Care Manager and Social Worker teams are assigned to patients by physician practice) to address patient care transition needs. Provides leadership in the integration of utilization and care management principles throughout the hospital.

Responsibilities

Duties and Responsibilities

• Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
• Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
• Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
• Assists the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost.
• Identifies conditions which require care management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
• Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
• Assists with the collection and analysis of utilization patterns and denied cases.
• Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).

Common Expectations:

• Prepares and maintains appropriate documentation as required.
• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Qualifications
Minimum Education:

• Associate's degree Required

Work Experience:

• 2 years Recent acute care experience. Required
• Utilization management, care management, or clinical nursing specialty. Preferred
• Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred

Licenses:

• Licensed Registered Nurse Upon Hire Required or
• Registered Nurse Multi State License Upon Hire Required and
• Basic Life Support Upon Hire Required

Knowledge, Skills, and Abilities:

About Us

WellSpan Health’s vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region’s largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.

About the Team

WellSpan Ephrata Community Hospital

One of eight premier hospitals in the WellSpan system, WellSpan Ephrata Community Hospital offers a full range of leading-edge inpatient, outpatient and emergent care services. The hospital is noted for its distinct ability to combine state-of-the-art medical technology with quality, compassionate care to meet the needs of the more than 550,000 residents of northern Lancaster County and the surrounding area. As a full-service, non-profit acute-care hospital, with a 141 licensed bed capacity, WellSpan Ephrata Community Hospital admits approximately 5,500 patients annually. Nearby WellSpan Ephrata Cancer Center supports the hospital as part of WellSpan’s regional network of five cancer centers. WellSpan Ephrata Community Hospital was one of several WellSpan Health hospitals honored by U.S. News & World Report with the High Performing recognition for 2022-23.