RN Care Manager - Care Coordination Integration - GHP
Location: Lewistown, Pennsylvania
Type: Full Time
Internal Number: R-21763
Are you a RN looking to join our team of Healthcare Heroes? Through professional growth, quality improvement, and interdisciplinary collaboration, we've built an innovative culture that allows nurses to grow their skillsets, develop their practice, and leverage their years of experience to build a rewarding, lasting career with impact. Our Geisinger nurses make a difference in the lives of the people they see every day- our friends, neighbors, and family members.Join our Geisinger Health Plan family as a RN Care Manager. In this innovative role, you will have the opportunity to work side by side with the Emergency Department nursing and physician to directly impact a patient's diversion from hospital admission by securing community based resources to manage care safely and comfortably from a patient's home. Prior experience working in an Emergency Room and Care Management preferred.
Works with physician and multidisciplinary team members to develop plan of care for each assigned patient from admission through discharge. Ensure patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and evaluations. Assess and respond to patient and family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care.
Works in conjunction with physicians, nurses, inter disciplinary team and others to assess, plan and initiate patient plan of care.
Facilitates and coordinates details of the actual discharge to appropriate agencies.
Facilitates and coordinates an individualized care coordination plan.
Serves as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning.
Completes appropriate federal, state and local forms.
Ensures adherence to quality standards and participation in quality monitoring and improvement by monitoring quality of care using predetermined criteria, reporting potential risk and quality management issues identified from medical record review to appropriate departments through defined processes, and enters data as requested and appropriate for role, to support quality improvement initiatives into appropriate system.
Conducts on-going case review for delays or variances in care; raises issues with appropriate department, attending physician and physician designee.
Captures data per department policy.
Communicates to appropriate physician identified issues for resolution and intervention.
Uses approved medical necessity criteria as a tool to ensure that patients meet appropriateness of the setting.
Actively involves payer liaison role in any case that has potential of not meeting medical necessity guidelines.
Supports payer liaison role to resolve barriers through appropriate administrative and medical channels to avoid third party payer denials.
Maintains awareness of all concurrent denials through interaction with payer liaison.
Works with payer liaison to facilitate timely discharge or alternative plan of care acceptable to physician, family and payer.
Work is typically performed in a clinical and office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.
Join the Geisinger Family a RN Case Manager for our Geisinger Health Plan. As a RN Case Manager you will directly impact your patient's life by connecting them to community resources to reduce hospital admissions and ER visits. Through collaboration with the patient, their family, providers, etc you will develop a plan of care that will provide your patient with the level of care needed to live safely and healthy in their home.
Our ideal candidate will have at least 3 years of RN experience. Prior Acute Care, Home Health or Case Management experience is helpful.
Typical hours are from 8:30 AM to 5:00 PM
May require future on call and weekends as needed
Travel up to 25% may be required for trainings and meetings
We're proud to offer competitive salaries and a comprehensive benefits package that includes:
Medical, prescription drug, vision and dental coverage
Family Support (Fertility and Adoption Support)
Employer contribution to your retirement plan
Tuition assistance (part time and full time roles only)
Generous paid time off packages that allows you to take the time you need to travel, rest, and care for and reconnect with friends and family.
Professional opportunities for growth and advancement
Support and mentorship from a full range of dedicated and experienced nursing leaders
Community Involvement through our Employee Resources Groups
Graduate from Specialty Training Program-Nursing (Required), Bachelor's Degree-Healthcare Related Degree (Preferred)
Minimum of 3 years-Nursing (Required)
Certification(s) and License(s)
Basic Life Support Certification - Default Issuing Body; Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.