York, PA, United States
Healthcare, Nursing, Case Management
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
2 - 3 years recent acute care
nursing experience in discharge planning or telephonic case management experience
Registration and current RN license in PA
Preferred candidates are certified case managers or have experience with discharge planning, workersâ€™ compensation, and outpatient care coordination, Utilization management, case management, or clinical nursing specialty
Familiar with utilization management process/criteria
Local travel required
York, Pennsylvania, United States
Website : http://www.yorkhospital.com/