Case Manager
2 months ago
Ensure all your application information is up to date and in order before applying for this opportunity.
General Summary
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 with social worker teams and are assigned to patient care areas to address patient discharge needs. Provides leadership in the integration of utilization and case management principles.
Duties and Responsibilities
Essential Functions:
Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
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.
Identifies conditions which require case management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
Assists with the collection and analysis of utilization patterns 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:
Demonstrate knowledge of the principles of growth and development over the life span of the assigned patient population. Assesses and interprets patient age specific data and provides appropriate, age specific treatment.
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.
Develops and initiates educational programs regarding utilization 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
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 Gettysburg Hospital
Celebrating over 100 years of community care, WellSpan Gettysburg Hospital is a nationally recognized acute care community hospital, serving more than 100,000 residents from the greater Adams County and northern Maryland area. The hospital offers services that include neurosciences, orthopedics, oncology and infusion, OB/GYN and interventional heart and vascular care. Our patients can receive a full range of heart services close to home— from preventative care and diagnostics to medical and interventional treatments, to cardiac rehabilitation. The specialists of WellSpan Cardiology perform procedures at WellSpan Gettysburg Hospital’s newly renovated catheterization lab, equipped with the latest technology and equipment.
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
Knowledge, Skills, and Abilities:
Excellent interpersonal/communication skills.
Basic computer skills.
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