Case Manager-RN

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

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

Duties and Responsibilities Essential Functions:

• 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.

Required for All Jobs:

• Performs other related duties as identified.
• WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
• WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Physical Demands:

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Frequently
• Reaching - Rarely
• Talking - Frequently
• Hearing - Frequently
• Repetitive Motions - Occasionally
• Eye/Hand/Foot Coordination - Occasionally

Working Environment:

• Occupational Hazards - Occasionally

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.

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.

WellSpan York Hospital

Built on a solid 140-year legacy of providing high-quality, high-volume, community-based care, WellSpan York Hospital, the largest of WellSpan’s eight hospitals, is a 596-bed acute care community teaching hospital that employs nearly 5,000 people, making WellSpan the largest employer in York County. Driven by a mission to provide exceptional care to all, WellSpan York Hospital serves a diverse population of more than 520,000 residents from the greater York County area. WellSpan York Hospital was one of several WellSpan Health hospitals honored by U.S. News & World Report with the High Performing recognition for 2022-23.

The hospital offers services and programs that feature highly skilled clinical staff, life-saving technology and state-of-the-art facilities to address some of the most complex medical, surgical and behavioral health conditions.

WellSpan York Hospital’s Regional Resource/Level 1 Trauma Center has been accredited by the Pennsylvania Trauma Systems Foundation and is the only accredited trauma center in York, Adams and Franklin counties. It is a nationally recognized teaching hospital with nine residency programs, six allied health schools and other training programs. More than 700 physicians and other professionals are members of WellSpan York Hospital’s medical and dental staff.

WellSpan York Hospital in embarking on a significant five-year project. The centerpiece will be a new, eight-story surgical and critical care tower, which will dramatically expand the hospital’s intensive care unit as well as develop new state of-the-art surgical suites, making it one of the top 10 largest hospitals in Pennsylvania with approximately 600 beds.