Post Acute Transitions Case Manager (RN) - Medical Management

York, PA | Professional | Tracking Code: 56827

Position Summary:

 

 

General Summary:


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.
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).

 

 

Required Skills

 

2 - 3 years recent acute care nursing experience in discharge planning or telephonic case management experience                                     

Req Cert/Registration: Registration and current RN license in PA

Preferred candidates are certified case managers or have experience with discharge planning, workers’ compensation, and outpatient care coordination, Utilization management, case management, or clinical nursing specialty

 


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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