Care Management Nurse (RN)

York, PA | Nursing | Tracking Code: 57912

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Position Summary:

General Summary:
RN  Under general supervision, registered nurse performs a variety of reviews 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. Provides leadership in the integration of utilization management principles throughout the System.


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 payors 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 Assists with the collection and analysis of utilization patterns and denied cases.
7 Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the
appropriate manager(s).

Department Description:

WellSpan Population Health Services provides coordination of health benefits offering a Preferred Provider Organization supporting accountable care and medical management which includes case management and utilization management. WellSpan Population Health Services is committed to provide care in compliance with the WellSpan triple aim: to improve the cost, quality, and patient experience in an efficient and effective delivery system for patients and providers.
 
Required Skills

2 - 3 years of acute care RN work experience

Utilization management, case management, or clinical nursing specialty expertise

Requires payer utilization, case management, and appeals experience

Active PA RN license required

Strong PC skills

Strong communication skills

Must be able self directed and autonomous in work habits

Detail-oriented

Required Experience

Full time (80 hours biweekly)

Mon-Fri

day shift

telephonic/remote position- must be within commutable distance to York offices, in home/onsite visits monthly


Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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