Job Description

8:30am to 9:00pm

Shifts primarily covering the Emergency Departments but also flexing to in house units based upon department needs

Weekend and holiday rotations required

Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred

General Summary

Performs a variety of duties and applies utilization and care 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 (Care 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 care management principles throughout the hospital.

Duties and 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).

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.

Qualifications

Minimum Education:

• Associates Degree Required

Work Experience:

• 2 years Recent acute care experience. Required
• Utilization management, care management, or clinical nursing specialty. Preferred
• Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred

Licenses:

• Licensed Registered Nurse Upon Hire Required or
• Registered Nurse Multi State License Upon Hire Required and
• Basic Life Support Upon Hire Required

Knowledge, Skills, and Abilities:

• Excellent interpersonal/communication skills.

Benefits Offered:

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)

WellSpan Health’s vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region’s largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.