RN Care Management Nurse, ED/IP Team

WellSpan Health; York (York County); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Comprehensive health benefits

Flexible spending & Health Savings

Retirement savings plan

Paid time off (PTO)

Short-term disability

Education assistance

DailyPay

Wellness programs

Caregiver support via Wellthy

Childcare referral via Wellthy

Job summary

WellSpan Health in York, PA is seeking an experienced Registered Nurse for a Care Coordination/Utilization Management role. The position involves reviewing medical necessity, coordinating care, and guiding discharge planning within a team-based model.

The ideal candidate has 5 years of RN experience, ED exposure is preferred, and active RN licensure with BLS certification is required. Excellent communication skills are essential for collaboration with care teams and payers.

Qualifications

• Associates Degree Required.
• 5 years of RN experience required.
• ED experience preferred.
• Licensed Registered Nurse Upon Hire Required or Registered Nurse Multi State License Upon Hire Required.
• Basic Life Support Upon Hire Required.
• Excellent interpersonal/communication skills.

Responsibilities

• 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).

Skills

RN experience

ED experience preferred

Interpersonal communication

Education

Associate's Degree

RN licensure

BLS Certification

Job description

WellSpan Health in York, PA is seeking an experienced Registered Nurse for a Care Coordination/Utilization Management role. The position involves reviewing medical necessity, coordinating care, and guiding discharge planning within a team-based model.

The ideal candidate has 5 years of RN experience, ED exposure is preferred, and active RN licensure with BLS certification is required. Excellent communication skills are essential for collaboration with care teams and payers.