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WellSpan Health
Case Management Nurse/Care Management
Job Location: York, PA
Department:
Care Management
Facility:
York Hospital
Shift:
PRN / Days/Evenings
Hours:
Cover for staff primarily Monday and Friday.
Job Summary:
General Summary:
Under the general supervision of the Supervisor-Case Management, performs a variety of duties and applies utilization and case 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 model (Case Management Nurse and Social Worker teams are assigned to patient care areas) to address patient discharge needs. Provides leadership in the integration of utilization and case management principles throughout the Hospital.
Duties and Responsibilities:
The following are essential job accountabilities:
1 Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
2 Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
3 Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
4 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.
5 Identifies conditions which require case management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
6 Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
7 Assists with the collection and analysis of utilization patterns and denied cases.
8 Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).
The following are common expectations:
9 Prepares and maintains appropriate documentation as required.
10 Maintains established policies and procedures, objectives, quality assessment and safety standards.
11 Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
The following are nonessential job accountabilities for ADA purposes:
12 Prepares and presents utilization data analysis as required.
13 Develops and initiates educational programs regarding utilization management principles.
14 Attends meetings as required.
Performs other related duties as identified.
Qualifications:
Note: Other combinations of formal education, training and experience may be considered.
Minimum Education
Associate's Degree
Minimum
Experience 2 - 3 years recent acute care
Pref Field Of Expertise
Utilization management, case management, or clinical nursing specialty
Req Cert/Registration
Registration and current RN license in PA
Physical Demands
Mostly sedentary work
Occasional prolonged standing/walking
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
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WellSpan Health
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