Case Manager: Optimize Care & Resource Use

Socket.dev; York (York County); On-site; USD 70,000 - 90,000; Full time

Job summary

WellSpan York Hospital is seeking a Registered Nurse for utilization management and case management. The role focuses on medical necessity reviews, appropriate discharge planning, and collaboration with care teams to optimize throughput and cost of care.

The position requires an associates degree with an RN license; a bachelor’s degree is preferred, plus 2 years of acute care experience and CCM certification is encouraged.

Qualifications

• Associates Degree required; Bachelors preferred.
• 2 years of recent acute care experience required.
• Licenses: RN upon hire; multi-state license; BLS; CCM preferred.

Responsibilities

• Reviews assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization.
• Initiates problem-solving techniques to prevent over- and under-utilization.
• Facilitates and coordinates progression of patient care to optimize throughput and resource utilization.
• Liaisons between utilization management, third party payers, and treatment teams regarding the treatment plan.
• Assists with discharge planning, including DME, Home Health, IV antibiotics, etc.
• Collaborates with care teams to identify interdisciplinary needs and transitions to value-based care initiatives.
• Prepares utilization data analysis and participates in education and process improvements.

Skills

Interpersonal skills

Communication skills

Basic computer skills

Education

Associates Degree Required

Bachelors Degree Preferred

Job description

WellSpan York Hospital is seeking a Registered Nurse for utilization management and case management. The role focuses on medical necessity reviews, appropriate discharge planning, and collaboration with care teams to optimize throughput and cost of care.

The position requires an associates degree with an RN license; a bachelor’s degree is preferred, plus 2 years of acute care experience and CCM certification is encouraged.