Schedule

Full Time: 72 Hours/Biweekly

Hours: 7:00pm - 7:00am

ED Case Management

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.

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 needsCollaborates 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.

Qualifications

Minimum Education:

Associates Degree RequiredBachelors Degree Preferred

Work Experience:

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

Licenses:

Licensed Registered Nurse Upon Hire Required orRegistered Nurse Multi State License Upon Hire Required andBasic Life Support Upon Hire RequiredCertified 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.

Benefits Offered:

Comprehensive health benefitsFlexible spending and health savings accountsRetirement savings planPaid time off (PTO)Short-term disabilityEducation assistanceFinancial education and support, including DailyPayWellness and Wellbeing programsCaregiver support via WellthyChildcare referral service via Wellthy You’re unique and you belong here.

At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email at . We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.