Care Management Nurse

Shifts are primarily 8:30am to 9:00pm covering the Emergency Departments, with flexibility to work in-house units based on department needs. Weekend and holiday rotations are required.

About the role

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 healthcare. Works within a Care Coordination Team (CCT) Model, collaborating with Care Managers and Social Workers assigned to patients by physician practice to address patient care transition needs. Provides leadership in integrating utilization and care management principles throughout the hospital.

Responsibilities

• Performs initial reviews for medical necessity and appropriateness of setting for the assigned caseload.
• Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques to prevent over- and/or under-utilization.
• Liaises 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 identifying and coordinating alternative treatment settings to provide appropriate care, maintain quality, and reduce costs.
• Identifies conditions requiring care management across the continuum and collaborates with the patient care team to address interdisciplinary needs.
• Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families, and the care team.
• 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 appropriate managers.
• 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.

Requirements

• Associate’s Degree (Required).
• 2 years of recent acute care experience (Required).
• Utilization management, care management, or clinical nursing specialty experience (Preferred).
• Previous experience in care management, discharge planning, or nursing experience in ED, critical care, trauma, step-down units, medical, surgical, or geriatrics (Strongly Preferred).
• Licensed Registered Nurse (Upon Hire, Required) or Registered Nurse Multi-State License (Upon Hire, Required).
• Basic Life Support certification (Upon Hire, Required).

Skills

• Excellent interpersonal and communication skills.

Benefits

• Comprehensive health benefits.
• Retirement savings plan.
• Paid time off (PTO).
• Education assistance.
• Financial education and support, including DailyPay.
• Expanded Paid Parental Leave.

About Us

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 of 23,000, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions.

About The Team

WellSpan Ephrata Community Hospital is one of eight premier hospitals in the WellSpan system, offering a full range of leading-edge inpatient, outpatient, and emergent care services. The hospital is noted for combining state-of-the-art medical technology with quality, compassionate care to meet the needs of over 550,000 residents in northern Lancaster County and the surrounding area. As a full-service, non-profit acute-care hospital with 141 licensed beds, WellSpan Ephrata Community Hospital admits approximately 5,500 patients annually. The nearby WellSpan Ephrata Cancer Center supports the hospital as part of WellSpan’s regional network of five cancer centers. WellSpan Ephrata Community Hospital was honored by U.S. News & World Report with the High Performing recognition for 2022-23.