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Care Management Nurse
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UPMC
Full-Time
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Job Description
WellSpan Health
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Care Management Nurse
- ED/IP Team
- Weekend Option 3 York, PA Posted 2 days ago Apply Now Weekend Option 3
- 50/52 weekends Day shift: 7am-7pm Split weekends in the ED and IP Team General Summary Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care.
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 care 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:
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.Benefits Offered:
Comprehensive health benefits Flexible spending and health savings accounts Retirement savings plan Paid time off (PTO) Short-term disability Education assistance Financial education and support, including DailyPay Wellness and Wellbeing programs Caregiver support via Wellthy Childcare referral service viaWellthy Qualifications Minimum Education:
Associates Degree Required Work Experience:
5 years of RN experience required ED experience preferred Utilization management, care 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. Quality of Life Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation. Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more- within an easy drive of major East Coast cities.