Case Manager RN (Lewisburg)

WellSpan Health•Lewisburg, PA

About The Position

The Case Manager RN applies utilization and case management techniques to determine efficient use of resources, support patients’ progression of care, and promote appropriate, cost-effective, quality health care. Working in a team model with social work in assigned patient care areas, the role addresses patient discharge needs and provides leadership in integrating utilization and case management principles. The position is full-time at 80 hours biweekly, with weekday daytime hours from 8:00 a.m. to 4:30 p.m. and rotating weekends and holidays.

Requirements

Associate's degree required.
Two years of recent acute care experience required.
Licensed Registered Nurse upon hire, or Registered Nurse Multi State License upon hire.
Basic Life Support upon hire.
Excellent interpersonal and communication skills.
Basic computer skills.
Desire and ability to work in a supportive, collaborative team environment.

Nice To Haves

Bachelor's degree preferred.
Experience in utilization management, case management, or a clinical nursing specialty preferred.
Certified in Case Management preferred.

Responsibilities

Review assigned patients for medical necessity, utilization management, and appropriateness of the setting for continued hospitalization.
Use problem-solving techniques to prevent overutilization or underutilization.
Facilitate and coordinate patient care progression to optimize throughput and resource use in support of quality and cost-of-care efforts.
Liaise among the utilization management team, third-party payers, and treatment team regarding treatment plans in accordance with contractual guidelines and system policy.
Help the patient care team identify and coordinate alternative treatment settings that maintain appropriate, quality care while reducing costs.
Identify conditions requiring case management across the care continuum.
Collaborate with the patient care team to identify interdisciplinary needs and with system care management teams to transition care and support value-based care initiatives.
Complete case management assessments, identify patient needs, develop discharge plans, and coordinate discharge needs such as durable medical equipment, home health, and IV antibiotics with patients, families, and the care team.
Assist with collecting and analyzing utilization patterns, length of stay, readmissions, avoidable days, and denied cases.
Bring known or suspected under-, over-, or inappropriate utilization of resources to the attention of appropriate managers.
Comply with applicable safety regulations, report actual and potential errors and hazardous conditions, identify opportunities to improve safety, and participate in safety education and root cause analyses as required.
Prepare and maintain required documentation and follow established policies, procedures, objectives, quality assessments, and safety standards.
Provide outstanding customer service, foster teamwork, and practice fiscal responsibility through improvement and innovation.
Prepare and present utilization data analysis as required.
Participate in developing and delivering education and process improvements related to job responsibilities and case management principles.
Attend meetings as required.