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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

Essential Functions:

+ 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.

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

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.

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 Chambersburg Hospital

Established in 1895 and located in the heart of Franklin County, WellSpan Chambersburg Hospital has long served its South Central Pennsylvania community with award-winning care. WellSpan Chambersburg Hospital's 274-bed facility provides a community of 156,000 residents full-range inpatient, outpatient and emergent care services. The hospital is noted for its leading-edge technology and full range of medical services, including award-winning heart and stroke care, a cardiac catheterization lab, a family birthing unit and Level II NICU, inpatient rehabilitation, a wound center with hyperbaric oxygen therapy, and surgical services, including robotic surgery. At WellSpan Chambersburg Hospital, we work together to provide our neighbors with important health-related programs focused on disease prevention and management, early detection screening, and tools and resources to prevent disease through health fairs, seminars, children's events, "fun runs," and more. WellSpan Chambersburg Hospital was one of several WellSpan hospitals honored by U.S. News & World Report with the High Performing recognition for 2022-23.

Quality of Life

Franklin County, named after Benjamin Franklin, was officially formed in 1784. One of its two main towns, the borough of Chambersburg, lies 13 miles north of Maryland and is known for its "green, safe environment." In the southern part of Franklin County, the borough of Waynesboro sits just two miles north of the Mason-Dixon Line and is known for its rich industrial history.

Franklin County is in the heart of Central Pennsylvania, where you'll find mountains, lakes and a picturesque countryside coupled with theater, music, skiing, hunting, fishing and much more. We're in the heart of America's fruit orchards, so peaches, apples and lots of other local produce are available close by. The area features local wineries and breweries, along with a vibrant arts scene at the historic Capitol Theatre and Totem Pole Playhouse. Franklin County merges the best of small-town friendliness with easy access to metropolitan areas. (Patient population: 154,000)

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.