Case Manager-RN

General Summary

Performs a variety of duties and applies utilization and case management
techniques to determine the most efficient use of resources to facilitate a
patient's progression of care and the provision of appropriate, cost effective
and quality health care. Works in a team model with social work in assigned
patient care areas to address patient discharge needs. Provides leadership in
the integration of utilization and case management principles.

Responsibilities

Duties and Responsibilities

Essential Functions

* Reviews assigned patients for medical necessity, utilization management, and
appropriateness of setting for continued hospitalization.
* Initiates problem-solving techniques to prevent over and/or under
utilization.
* Facilitates and coordinates the progression of patient care to optimize
throughput and the utilization of resources to support continuous quality and
cost of care efforts.
* Liaisons between utilization management team, third party payers, and the
treatment team regarding the identified treatment plan in accordance with
contractual guidelines and System policy.
* Assists the patient care team with the identification and coordination of
alternative treatment settings to provide appropriate care, maintain quality
of care, and reduce cost.
* Identifies conditions which require case management across the care
continuum. Collaborates with members of the patient care team to identify
interdisciplinary needs
* Collaborates with care management across the system to effectively transition
patient care and support value-based care initiatives.
* Completes case management patient assessment, identifies needs, develops a
discharge plan, and coordinates discharge needs (DME, Home Health, IV
antibiotics, etc.) in collaboration with patients, families, and care team.
* Assists with the collection and analysis of utilization patterns, length of
stay, readmissions, avoidable days, and denied cases.
* Brings known or suspected problems of under-, over-, or inappropriate
utilization of resources to the attention of the appropriate manager(s).

Common Expectations

* Demonstrates a commitment to patient, visitor, and staff by complying with
all applicable safety regulations, learning the impact of medical errors and
methodology that will lead to reduction of errors; reporting actual and
potential errors, as well as hazardous conditions; identifying opportunities
to standardize processes and “error proof” systems that will lead to
increased safety; and participating in safety education programs and root
cause analyses as required.
* Prepares and maintains appropriate documentation as required.
* Maintains established policies and procedures, objectives, quality assessment
and safety standards.
* Provides outstanding service to all customers; fosters teamwork; and
practices fiscal responsibility through improvement and innovation.
* Prepares and presents utilization data analysis as required.
* Participates in the development and delivery of educational information and
process improvements related to job accountabilities and case management
principles.
* Attends meetings as required.

Required for All Jobs

* Performs other related duties as identified.
* WellSpan Health has adopted and implemented a compliance program to support
WellSpan's values and standards for professionalism, integrity, and ethics.
Expected to support and meet the values and standards of the organization and
the performance expectations of the job, the department, and the compliance
program.
* WellSpan Health has adopted and implemented a privacy program to safeguard
the patient information and the business and operational information of the
organization. Expected to support and meet the values and standards of the
organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of
work being performed. They are not intended to be construed as an exhaustive
list of all responsibilities, duties, and skills required of personnel so
classified.

Physical Demands

* Standing - Occasionally
* Walking - Occasionally
* Sitting - Frequently
* Reaching - Rarely
* Talking - Frequently
* Hearing - Frequently
* Repetitive Motions - Occasionally
* Eye/Hand/Foot Coordination - Occasionally

Working Environment

* Occupational Hazards - Occasionally

Qualifications

Qualifications

Minimum Education

* Associates Degree Required
* Bachelors Degree Preferred

Work Experience

* 2 years Recent acute care experience Required
* Field of Experience in Utilization Management, Case Management, or Clinical
Nursing Specialty. Preferred

Licenses

* Licensed Registered Nurse Upon Hire Required or
* Registered Nurse Multi State License Upon Hire Required and
* Basic Life Support Upon Hire Required
* Certified in Case Management Preferred

Knowledge, Skills, and Abilities

* Excellent interpersonal and communication skills.
* Basic computer skills.
* Desire and ability to work in a supportive and collaborative team
environment.

WellSpan Health’s vision is to reimagine healthcare through the delivery of
comprehensive, equitable health and wellness solutions throughout our continuum
of care. As an integrated delivery system focused on leading in value-based
care, we encompass more than 2,300 employed providers, 250 locations, nine
award-winning hospitals, home care and a behavioral health organization serving
central Pennsylvania and northern Maryland. Our high-performing Medicare
Accountable Care Organization (ACO) is the region’s largest and one of the best
in the nation. With a team 23,000 strong, WellSpan experts provide a range of
services, from wellness and employer services solutions to advanced care for
complex medical and behavioral conditions. Our clinically integrated network of
3,000 aligned physicians and advanced practice providers is dedicated to
providing the highest quality and safety, inspiring our patients and communities
to be their healthiest.

WellSpan York Hospital

Built on a solid 140-year legacy of providing high-quality, high-volume,
community-based care, WellSpan York Hospital, the largest of WellSpan’s eight
hospitals, is a 596-bed acute care community teaching hospital that employs
nearly 5,000 people, making WellSpan the largest employer in York County. Driven
by a mission to provide exceptional care to all, WellSpan York Hospital serves a
diverse population of more than 520,000 residents from the greater York County
area.  WellSpan York Hospital was one of several WellSpan Health hospitals
honored by U. S. News & World Report with the High Performing recognition for
2022-23.

The hospital offers services and programs that feature highly skilled clinical
staff, life-saving technology and state-of-the-art facilities to address some of
the most complex medical, surgical and behavioral health conditions.  

WellSpan York Hospital’s Regional Resource/Level 1 Trauma Center has been
accredited by the Pennsylvania Trauma Systems Foundation and is the only
accredited trauma center in York, Adams and Franklin counties.  It is a
nationally recognized teaching hospital with nine residency programs, six allied
health schools and other training programs.  More than 700 physicians and other
professionals are members of WellSpan York Hospital’s medical and dental
staff.  

WellSpan York Hospital in embarking on a significant five-year project.  The
centerpiece will be a new, eight-story surgical and critical care tower, which
will dramatically expand the hospital’s intensive care unit as well as develop
new state of-the-art surgical suites, making it one of the top 10 largest
hospitals in Pennsylvania with approximately 600 beds.