Case Management Nurse - Weekend Option - Days
General Summary
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 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 Responsibilities
Essential 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 - Occasionally
Walking - Occasionally
Sitting - Frequently
Reaching - Rarely
Talking - Frequently
Hearing - Frequently
Repetitive Motions - Occasionally
Eye/Hand/Foot Coordination - Occasionally
Working Environment:
Occupational Hazards - Occasionally
Qualifications
Minimum Education:
Associates Degree Required
Work
Experience:
2 years Recent acute care experience. Required
Utilization management, case management, or clinical nursing specialty. Preferred
Licenses:
Licensed Registered Nurse Upon Hire Required or
Registered Nurse Multi State License Upon Hire Required and
Basic Life Support Upon Hire Required
Courses and Training:
Clearance per Child Protective Services law (11P.S. 2201) amended by PA Act 33 of 1985. Upon Hire Required
Knowledge, Skills, and Abilities:
Excellent interpersonal/communication skills.
Employment Benefits
Sign-on incentives for new employees
Medical, dental and vision insurance
Life and accidental death insurance
Supplemental life insurance
Retirement savings plan
Paid time off (PTO)
PTO bridging
Short-term disability
Educational assistance
Forgivable loan
Flexible spending
Credit union
Employee recreational activities
Childcare
Complimentary medicine discountsEstimated Salary: $20 to $28 per hour based on qualifications.
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 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 Responsibilities
Essential 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 - Occasionally
Walking - Occasionally
Sitting - Frequently
Reaching - Rarely
Talking - Frequently
Hearing - Frequently
Repetitive Motions - Occasionally
Eye/Hand/Foot Coordination - Occasionally
Working Environment:
Occupational Hazards - Occasionally
Qualifications
Minimum Education:
Associates Degree Required
Work
Experience:
2 years Recent acute care experience. Required
Utilization management, case management, or clinical nursing specialty. Preferred
Licenses:
Licensed Registered Nurse Upon Hire Required or
Registered Nurse Multi State License Upon Hire Required and
Basic Life Support Upon Hire Required
Courses and Training:
Clearance per Child Protective Services law (11P.S. 2201) amended by PA Act 33 of 1985. Upon Hire Required
Knowledge, Skills, and Abilities:
Excellent interpersonal/communication skills.
Employment Benefits
Sign-on incentives for new employees
Medical, dental and vision insurance
Life and accidental death insurance
Supplemental life insurance
Retirement savings plan
Paid time off (PTO)
PTO bridging
Short-term disability
Educational assistance
Forgivable loan
Flexible spending
Credit union
Employee recreational activities
Childcare
Complimentary medicine discountsEstimated Salary: $20 to $28 per hour based on qualifications.
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