Hybrid Case Management Nurse-RN Weekend Option 3 - Days at WellSpan Medical Group
WellSpan Medical Group · York, United States Of America · Hybrid
- Office in York
Part-time (48 hours biweekly)
Every Saturday and Sunday
7 am to 7 pm
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.
Responsibilities
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.
Qualifications
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.
Benefits Offered:
- Comprehensive health benefits
- Flexible spending and health savings accounts
- Retirement savings plan
- Paid time off (PTO)
- Short-term disability
- Education assistance
- Financial education and support, including DailyPay
- Wellness and Wellbeing programs
- Caregiver support via Wellthy
- Childcare referral service via Wellthy
For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)
