Case Management Nurse - Weekend Option - Days
Company: Wellspan Health Services
Location: York
Posted on: May 8, 2024
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Job Description:
General SummaryPerforms 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 type
assignment or Care Coordination Team (CCT) Model (Case 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 case management principles
throughout the hospital.Duties and ResponsibilitiesEssential
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 case 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.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.Physical Demands:Standing - OccasionallyWalking -
OccasionallySitting - FrequentlyReaching - RarelyTalking -
FrequentlyHearing - FrequentlyRepetitive Motions -
OccasionallyEye/Hand/Foot Coordination - OccasionallyWorking
Environment:Occupational Hazards -
OccasionallyQualificationsMinimum Education:Associates Degree
RequiredWork Experience:2 years Recent acute care experience.
RequiredUtilization management, case management, or clinical
nursing specialty. PreferredLicenses:Licensed Registered Nurse Upon
Hire Required orRegistered Nurse Multi State License Upon Hire
Required andBasic Life Support Upon Hire RequiredCourses and
Training:Clearance per Child Protective Services law (11P.S. 2201)
amended by PA Act 33 of 1985. Upon Hire RequiredKnowledge, Skills,
and Abilities:Excellent interpersonal/communication
skills.Employment BenefitsSign-on incentives for new
employeesMedical, dental and vision insuranceLife and accidental
death insuranceSupplemental life insuranceRetirement savings
planPaid time off (PTO)PTO bridgingShort-term disabilityEducational
assistanceForgivable loanFlexible spendingCredit unionEmployee
recreational activitiesChildcareComplimentary medicine discountsby
Jobble
Keywords: Wellspan Health Services, Bethlehem , Case Management Nurse - Weekend Option - Days, Executive , York, Pennsylvania
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