Registered Nurse - Case Management - Weekend Plan

WellSpan Health; York (York County); On-site; USD 65,000 - 90,000; Part time

Job summary

WellSpan Health is seeking a part-time Weekend Plan utilization/care coordinator to support patient care transitions. The role involves 24 hours biweekly with Saturdays and Sundays, 7am–7pm, and eligibility for weekend premium.

You will participate in a Care Coordination Team and work with physicians and care managers to optimize hospital resource use. The ideal candidate holds an Associate’s degree, has 2 years of acute care experience and RN licensure with BLS, and demonstrates excellent

Qualifications

• 2 years of recent acute care experience.
• Utilization management or care management experience preferred.
• RN license and BLS required at hire.

Responsibilities

• Performs initial reviews for medical necessity and setting.
• Conducts concurrent reviews to ensure continued hospitalization.
• Liaisons with third party payers regarding treatment plans.
• Assists with discharge planning and coordination of care.
• Analyzes utilization patterns and denied cases.
• Escalates under- or over-utilization issues to management.

Skills

Interpersonal communication

Education

Associates degree

Job description

Job Description

Part-Time Weekend Plan 24 hours biweekly

Every Other Weekend Required

Schedule: Days - 7am-7pm

Saturday & Sunday

Eligible for Weekend Premium

General Summary: Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Works in a team type assignment or Care Coordination Team (CCT) Model (Care Manager and Social Worker teams are assigned to patients by physician practice) to address patient care transition needs. Provides leadership in the integration of utilization and care management principles throughout the hospital.

Responsibilities

Essential Functions

• Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
• Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
• Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
• Assists the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost.
• Identifies conditions which require care management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
• Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
• Assists with the collection and analysis of utilization patterns 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

• 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.

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.

Benefits Offered ( click here for more details )

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

Qualifications

Minimum Education

• Associates Degree Required

Work Experience

• 2 years Recent acute care experience. Required
• Utilization management, care 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

Knowledge, Skills, And Abilities

• Excellent interpersonal/communication skills.