Case Management Nurse - Waynesboro Hospital - Day

Schedule & Location:

PRN (As Needed)

Waynesboro Hospital 

Job Description:

Under the general supervision of the Supervisor-Case Management, 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

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 payers 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. Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
7. Assists with the collection and analysis of utilization patterns and denied cases.
8. Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).

Qualifications

• Minimum Experience:
  • 2 - 3 years recent acute care
• Minimum Education:
  • Associate's Degree
• Preferred Field Of Expertise:
  • Utilization management, case management, or clinical nursing specialty
• Required Certification:
  • Registration and current RN license in PA; Clearance per Child Protective Services law (11P.S. 2201) amended by PA Act 33 of 1985; BLS Certification
• Physical Demands:
  • Mostly sedentary work
  • Occasional prolonged standing/walking
  • Working conditions May be exposed to infections and contagious diseases
  • May be exposed to/occasionally exposed to patient elements
  • Subject to varying and unpredictable situations
  • Subject to many interruptions
  • May be exposed to the risk of bloodborne diseases
• Skills:
  • Excellent interpersonal/communication skills