Case Manager Nurse

WellSpan Health; Ephrata (Lancaster County); On-site; USD 75,000 - 100,000; Full time

Benefits offered by this job

Comprehensive health benefits

Paid time off (PTO)

Education assistance

DailyPay

Expanded Paid Parental Leave

Job summary

WellSpan Health in Ephrata, PA seeks an experienced registered nurse to join the utilization and case management team. You will collaborate with social work to ensure efficient patient progression and high-quality, cost-effective care.

The role involves reviewing medical necessity, coordinating care transitions, and liaising with payers and treatment teams to implement appropriate treatment plans. Full-time daytime position with weekend/holiday rotation.

Qualifications

• Associates Degree Required
• Bachelors Degree Preferred

Responsibilities

• Review assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization.
• Initiate problem-solving to prevent over- or under-utilization.
• Facilitate and coordinate progression of patient care to optimize throughput and resource use.
• Liaise between utilization management, payers, and treatment team per contract guidelines.
• Assist with identifying and coordinating alternative treatment settings to provide appropriate care and reduce cost.
• Identify interdisciplinary needs and collaborate with care team for transitions.
• Collaborate to transition patient care and support value-based care initiatives.
• Complete case management assessments, develop discharge plans, and coordinate discharge needs (DME, Home Health, IV antibiotics).
• Assist with collection and analysis of utilization patterns, length of stay, readmissions, and denied cases.

Skills

Interpersonal skills

Communication

Team collaboration

Computer skills

Education

Associates Degree

Bachelors Degree preferred

Tools

Electronic Health Records

Job description

General Summary

Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to facilitate a patient's progression of care and the provision of appropriate, cost effective and quality health care. Works in a team model with social work in assigned patient care areas to address patient discharge needs. Provides leadership in the integration of utilization and case management principles.

Job Description

Full-time Day Shift

72 hours bi-weekly

8:30am to 9pm

Weekend and holiday rotation

General Summary

Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to facilitate a patient's progression of care and the provision of appropriate, cost effective and quality health care. Works in a team model with social work in assigned patient care areas to address patient discharge needs. Provides leadership in the integration of utilization and case management principles.

Responsibilities

• Reviews assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization.
• Initiates problem-solving techniques to prevent over and/or under utilization.
• Facilitates and coordinates the progression of patient care to optimize throughput and the utilization of resources to support continuous quality and cost of care efforts.
• Liaisons between utilization management team, third party payers, and the treatment team regarding the identified treatment plan in accordance with contractual guidelines and System policy.
• Assists the patient care team with the identification and coordination of alternative treatment settings to provide appropriate care, maintain quality of care, and reduce cost.
• Identifies conditions which require case management across the care continuum. Collaborates with members of the patient care team to identify interdisciplinary needs
• Collaborates with care management across the system to effectively transition patient care and support value-based care initiatives.
• Completes case management patient assessment, identifies needs, develops a discharge plan, and coordinates discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families, and care team.
• Assists with the collection and analysis of utilization patterns, length of stay, readmissions, avoidable days, 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

• Demonstrates a commitment to patient, visitor, and staff by complying with all applicable safety regulations, learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and “error proof” systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required.
• 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.
• Prepares and presents utilization data analysis as required.
• Participates in the development and delivery of educational information and process improvements related to job accountabilities and case management principles.
• Attends meetings as required.

Qualifications

QUALIFICATIONS

Minimum Education

• Associates Degree Required
• Bachelors Degree Preferred

Work Experience

• 2 years Recent acute care experience Required
• Field of Experience in Utilization Management, Case Management, or Clinical Nursing Specialty. Preferred

Licenses

• Licensed Registered Nurse Upon Hire Required or
• Registered Nurse Multi State License Upon Hire Required and
• Basic Life Support Upon Hire Required
• Certified in Case Management Preferred

Knowledge, Skills, And Abilities

• Excellent interpersonal and communication skills.
• Basic computer skills.
• Desire and ability to work in a supportive and collaborative team environment.

Benefits Offered

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)

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.