Nurse Case Manager – Utilization & Discharge Lead

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

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.