Case Manager RN - Lewisburg

WellSpan Health; Lewisburg (Union County); On-site; USD 48,000 - 62,000; Part time

Job summary

WellSpan Health in Lewisburg, PA seeks a Part-time Nurse with utilization and case management responsibilities to support patient care needs in a team setting. The role involves evaluating medical necessity, coordinating through the discharge process, and ensuring cost-effective care delivery.

Shifts are 8:00am-4:30pm with potential weekday/weekend/holiday coverage as needed. This PRN/Per Diem position emphasizes collaborative work with social work and care teams to optimize patient flow and

Qualifications

• Associates degree required; bachelor’s degree preferred.
• 2 years of recent acute care experience.
• Experience in utilization management, case management, or clinical nursing preferred.

Responsibilities

• Review assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization.
• Initiate problem-solving to prevent over/under utilization of resources.
• Coordinate progression of patient care to optimize throughput and resource use.
• Liaise with utilization management, third-party payers, and treatment team about the plan per policy.
• Assist with discharge planning and coordination of post-discharge needs (DME, Home Health, IV antibiotics).
• Collaborate with care teams to identify interdisciplinary needs and transitions of care.

Skills

Interpersonal skills

Communication

Basic computer skills

Education

Associates Degree

Bachelors Degree

Job description

Job Identification 227243

Job Category Nursing

Job Schedule Part time

Job Shift Shift1 - Day

Locations 1 Hospital Dr, Lewisburg, PA, 17837, US

Assignment Category PRN/Per Diem

FTE 0.001

Job Description

PRN (As Needed)

8:00am-4:30pm

May be asked to work weekdays/weekends/holidays when coverage is needed to maintain adequate staffing

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

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.

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 is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.