RN Case Manager: Lead Care Transitions & Utilization

WellSpan Health; Lewisburg (Union County); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement savings plan

Paid time off (PTO)

Education assistance

Financial education and support, Daily

Expanded Paid Parental Leave

Job summary

WellSpan Health in Pennsylvania is seeking an experienced Registered Nurse for Utilization Management/Case Management to determine the most efficient use of resources and facilitate patient progression of care. You will work in a team model with social work in assigned patient care areas to address discharge needs.

The role includes reviewing medical necessity, coordinating discharge planning (DME, home health, IV antibiotics), partnering with payers and care teams, and promoting value-based

Qualifications

• Associate's degree required in nursing (ADN) or equivalent.
• Recent acute care experience (2 years) required.
• Licensed Registered Nurse in the state of hire, or multi-state license required.
• Basic Life Support (BLS) certification required.
• Certification in Case Management preferred.

Responsibilities

• Reviews assigned patients for medical necessity and utilization management.
• Coordinates discharge planning and transition of care.
• Liaises with utilization management, third-party payers, and the treatment team.
• Identifies opportunities to optimize resource use and reduce costs.
• Prepares utilization data analyses and reports.

Skills

Interpersonal skills

Communication skills

Basic computer skills

Team collaboration

Education

Associate degree

Bachelor's degree preferred

Job description

WellSpan Health in Pennsylvania is seeking an experienced Registered Nurse for Utilization Management/Case Management to determine the most efficient use of resources and facilitate patient progression of care. You will work in a team model with social work in assigned patient care areas to address discharge needs.

The role includes reviewing medical necessity, coordinating discharge planning (DME, home health, IV antibiotics), partnering with payers and care teams, and promoting value-based