Medical Policy RN - York, PA, United States - WellSpan Health Services

Description

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 type assignment or Care Coordination Team (CCT) Model (Case Manager and Social Worker teams are assigned to patients by physician practice) to address patient care transition needs.

Provides leadership in the integration of utilization and case management principles throughout the hospital.
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 case 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.
Maintains established policies and procedures, objectives, quality assessment and safety standards.

fosters teamwork; 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.

Work Experience:

2 years Recent acute care experience. Utilization management, case management, or clinical nursing specialty.


Courses and Training:
Clearance per Child Protective Services law (11P.Medical, dental and vision insurance
Retirement savings plan
Short-term disability
Flexible spending
Credit union
Childcare
Complimentary medicine discounts