Case Manager RN - Lewisburg

WellSpan Health; Lewisburg (Union County); On-site; USD 75,000 - 105,000; Full time

Job summary

WellSpan Health is seeking a PRN Utilization Management/Case Manager RN to join a collaborative care team in a hospital setting in Lewisburg, PA. You will review medical necessity, coordinate patient care progression, and liaise with payers to ensure appropriate and cost-effective hospitalization decisions.

Work in support of value-based care and discharge planning, including DME, home health, and IV antibiotics.

Qualifications

• Associates Degree required.
• Bachelor's Degree 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/or under-utilization.
• Facilitates and coordinates the progression of patient care to optimize throughput and utilization of resources for quality and cost of care.
• Liaisons between utilization management team, payers, and treatment team regarding the treatment plan per guidelines and policy.
• Assists the patient care team with identifying and coordinating alternative treatment settings to provide appropriate care and reduce cost.
• Identifies conditions requiring case management across the care continuum; collaborates with the care team to identify interdisciplinary needs.
• Collaborates with care management system-wide to transition patient care and support value-based care initiatives.
• Completes case management assessments, develops discharge plans, and coordinates discharge needs (DME, Home Health, IV antibiotics, etc.).
• Assists with collection and analysis of utilization patterns, length of stay, readmissions, avoidable days, and denials.
• Raises known or suspected problems of under/over/ inappropriate utilization to the appropriate manager.

Skills

Interpersonal skills

Communication

Team collaboration

Education

Associates Degree

Bachelors Degree

Job description

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

• 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

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.

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 Evangelical Community Hospital

Working at WellSpan Evangelical Community Hospital means being part of a vital tradition of service to our community. We maintain a challenging, energized work environment for our valued employees who exemplify our Core Values: Quality Service, Compassion, Respect, Professionalism, Integrity, Cooperation, and Creativity. Together, we commit to excellence every day as we strive to provide exceptional healthcare, accessible to all, in the safest and most compassionate atmosphere possible to build a healthy community.