RN - Registered Nurse - Case Manager - Care Coordination - GHP

Location: Work from home (Pennsylvania) Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: Yes Job Summary: Geisinger Health Plan is making better health easier and more accessible. We are consistently ranked for outstanding care and coverage, not just by independent reviewers, but by our members, that tells you something. Job Duties: Join Geisinger Health Plan as an RN Case Manager and make a meaningful impact through patient-centered care coordination. In this rewarding role, you'll support our vision of making better health easier while working alongside a collaborative team that is invested in your success, growth, and ability to deliver exceptional outcomes. At least two (2) years of RN work experience is required. Certified Case Manager / American Case Management Association (ACMA) is preferred. BSN is preferred. Case management experience is preferred. Knowledge of healthcare laws, regulations, and insurance coverage policies, and proficiency in healthcare IT systems and insurance claims processes is helpful. Ability to work autonomously and as part of a multidisciplinary team is helpful. A typical schedule is full-time, days. This role is Exempt/salaried. Benefits of working at Geisinger: Full benefits (health, dental and vision) starting on day one Three medical plan choices, including an expanded network for out-of-area employees and dependents Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA) Company-paid life insurance, short-term disability, and long-term disability coverage 401(k) plan that includes automatic Geisinger contributions Generous paid time off (PTO) plan that allows you to accrue time quickly Up to $5,000 in tuition reimbursement per calendar year MyHealth Rewards wellness program to improve your health while earning a financial incentive Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay and a free Care.com membership with discounted backup care for your loved ones Employee Assistance Program (EAP): Referrals for childcare, eldercare, & pet care. Access free legal guidance, mental health visits, work-life support, digital self-help tools and more. Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life and pet and legal insurance Position Details: Work is typically performed in a clinical 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. The RN Case Manager assesses, plans, implements, coordinates, monitors and evaluates all options and services with the goal of optimizing the patient or member's health status. Manages utilization and practice metrics to further refine the delivery of care model to maximize clinical, quality, and fiscal outcomes. Integrates evidence-based clinical guidelines, preventive guidelines, protocols, and other metrics in the development of treatment plans that are patient-centric, promoting quality and efficiency in the delivery of healthcare for the identified population. Develops systems of care that monitor progress and promote early intervention in acute care situations. Assists with the design, implementation, and evaluation of the advanced patient centered care model. Assesses the healthcare, educational and psychosocial needs of patients or members. Designs an individualized plan of care and fosters a team approach by working collaboratively with the patient or member, family, primary care provider, and other members of the health care team to ensure coordination of services. Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population. Works to appropriately apply benefits and utilization management serving as a resource to the patient or member and healthcare team. Maintains required documentation for all case management activities. Collects required data and utilizes this data to adjust the treatment plan when indicated. Education: Graduate from Specialty Training Program-Nursing (Required), Bachelor's Degree-Nursing (Preferred) Experience: Minimum of 2 years-Nursing (Required) Certification(s) and License(s): Licensed Registered Nurse (Penns #J-18808-Ljbffr geisinger