Case Manager - Registered Nurse

Chambersburg, PA | Nursing | Tracking Code: 73953

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Full time

8:30 am - 5:00 pm

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 model (Case Manager and Social Worker teams are assigned to patient care areas) to address patient discharge 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. 6Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
  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
  8. appropriate manager(s).
  9. Prepares and presents utilization data analysis as required.
  10. Develops and initiates educational programs regarding utilization management principles.
  11. Attends meetings as required.
  12. Performs other related duties as identified.
  13. Prepares and maintains appropriate documentation as required.
  14. Maintains established policies and procedures, objectives, quality assessment and safety standards.
  15. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement
  16. and innovation.
 

Qualifications

  • Notes:
    • Other combinations of formal education, training and experience may be considered.
  • 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
  • Physical Demands:
    • Mostly sedentary work
    • Occasional prolonged standing/walking
Ruth Ann Frey
Manager Talent, Diversity and Inclusion
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Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises a multispecialty medical group of more than 1,600 physicians and advanced practice providers, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 20,000 employees and 200 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.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • 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 discounts

Diversity & Inclusion

Welcome. Respect. Value.

Wellspan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected, and valued while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

Quality of Life

Franklin County, named after Benjamin Franklin, was officially formed in 1784. One of its two main towns, the borough of Chambersburg, lies 13 miles north of Maryland, and is known for its "green, safe environment." In the southern part of Franklin County, the borough of Waynesboro sits just two miles north of the Mason-Dixon Line and is known for its rich industrial history.

Franklin County is in the heart of South-Central Pennsylvania where you'll find mountains, lakes, and a picturesque countryside coupled with theater, music, skiing, hunting, fishing, and much more. We're in the heart of America's fruit orchards, so peaches, apples, and lots of other local produce are available close by. The area features local wineries and breweries, along with a vibrant arts scene at the historic Capitol Theatre and Totem Pole Playhouse. Franklin County merges the best of small-town friendliness with easy access to metropolitan areas. (Patient population: 154,000)