The posting
Job Description
Part-Time Day Shift
48 hours bi-weekly
8:30am to 9pm
Weekend and holiday rotation
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
- 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.
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.
Benefits Offered:
- Comprehensive health benefits
- Retirement savings plan
- Paid time off (PTO)
- Education assistance
- Financial education and support, including DailyPay
- Expanded Paid Parental Leave
For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)
