RN Case Manager: Discharge & Resource Optimization

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

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.