Part-time Day Shift 48 hours bi-weekly 8:30am to 9:00pm 2 days per week including Weekend and holiday rotations 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. 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 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)