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Posted: Monday, January 8, 2018 8:14 AM

General Summary:

Under the general supervision of the Supervisor-Case Management, performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Works in a team model (Case Manager and Social Worker teams are assigned to patient care areas) to address patient discharge needs. Provides leadership in the integration of utilization and case management principles throughout the Hospital.

Duties and Responsibilities:

1 Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.

2 Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving

techniques as needed to prevent over and/or under utilization.

3 Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with

contractual guidelines or System policy.

4 Assists the patient care team with the identification and coordination of alternative treatment settings which will provide

appropriate care, maintain quality of care and reduce cost.

5 Identifies conditions which require case management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.

6 Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.

7 Assists with the collection and analysis of utilization patterns and denied cases.

8 Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the

appropriate manager(s).

Department Description:

The WellSpan Medical Group is a large multi-specialty group spanning across south central Pennsylvania and northern Maryland. WellSpan Medical Group Providers and staff work together to offer care and treatment for conditions ranging from simple to complex. We employ a large array of specialists and experts to meet the needs of the communities we serve. The WellSpan Medical Group is proud of our collaborative culture and strong commitment to patients, families and visitors.

Please click here to learn more about WellSpan Medical Group or here to learn more about this practice.

About WellSpan:

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multi-specialty medical group of more than 850 physicians and advanced practice clinicians, a home care organization, six respected hospitals, more than 15,000 employees, and 160 patient care locations. The region's only accredited Level 1 Trauma Center and Primary Stroke Center with an endovascular neurosurgery program. WellSpan is consistently recognized by IMS Health as one of the Top 100 Integrated Health Networks in the United States and has been recognized by Health Imaging and IT as one of the nation's \"Top 25 Connected Healthcare Facilities.\" IMS Health is the leading provider of information services and technology for the healthcare industry.

The Community:

WellSpan Health facilities are located in multiple counties across south central Pennsylvania and northern Maryland, all offering an ideal living environment to match the quality of work-life balance you're seeking. The area offers abundant outdoor and cultural activities, including restaurants, theatre, golf courses, hiking trails, water sports and historic tours. Additionally, our communities are a short drive from several, large metropolitan areas including the Baltimore/DC metro area and Philadelphia.

If you value a strong sense of community, the more palatable pace of rural living, and the convenience of a workplace close to home, you'll realize the advantages of considering WellSpan Health as part of your future.

Required Experience

2-3 years recent acute care experience- Utilization management, case management, or clinical nursing specialty

Registration and current RN license in PA


Associated topics: ambulatory, care unit, ccu, hospice, infusion, intensive, intensive care, intensive care unit, neonatal, transitional


• Location: York

• Post ID: 60598702 york is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2018