Utilization Management Specialist - RN, LPN or LSW

Mt Gretna, PA | Behavioral Health | Tracking Code: 66370

PRN flexible day shift

 

Job Description:

Under direct supervision, performs a variety of duties related to pre-certification requirements for Medicare, Medical Assistance and third party payers. Assists with data collection, analysis and reporting.

 

Duties and Responsibilities

 

  1. Reviews assigned cases for preauthorization and coordinates authorization and certification.
  2. Performs concurrent review of cases to obtain continued stay authorization.
  3. Works closely with and prepares information for outside review agencies.
  4. Collects, reviews and retrieves data from records and reports for quality assessment, audit, study and research purposes.
  5. Supports the Utilization Management Nurse with case research and analysis.
  6. Works with medical and professional staff on a case-by-case basis to obtain appropriate clinical documentation for
  7. review as well as coding activities and DRG assignments.
 

Qualifications

 

  • Minimum Experience:
    • 2 - 3 years
  • Minimum Education:
    • Associate's level nurse
  • Liceusure Preferred:
    • LSW, RN or LPN in the state of Pennsylvania
  • Minimum Field Of Expertise:
    • Utilization Management and Behavioral Health
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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. 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.

Quality of Life

Formed in 1813, Lebanon is a quaint city of 25,700 residents. The area, rich in heritage and the small-town charm of yesteryear, features sites on the National Register of Historic Places, museums, scenic parks and recreation facilities, performing arts theaters, artists' studios, a farmers' market and dining establishments for all tastes.

Life in Lebanon County offers affordable housing and options for pursuing higher education. Residents can find local employment in manufacturing, retail, arts and entertainment, healthcare and service sectors. Located in southcentral Pennsylvania, Lebanon is within an easy driving distance to Harrisburg, Lancaster, Reading and York. (Patient population: 140,000)