RN - Registered Nurse Care Manager - Community Based

Geisinger•Danville, PA

About The Position

Geisinger at Home brings personalized healthcare directly to eligible Geisinger Gold Medicare Advantage members in their homes. This community-based RN role serves patients throughout Columbia, Montour, and Northumberland counties. The nurse works with physicians and multidisciplinary team members to develop individualized plans of care, monitor progress toward desired outcomes, coordinate care and discharge planning, and identify and resolve barriers to effective patient care. The role also supports quality monitoring and improvement, reviews cases for delays or variances, communicates issues to physicians and appropriate departments, applies approved medical necessity criteria, and works with payer liaisons to address coverage barriers and support timely discharge or an acceptable alternative plan of care. Work is typically performed in a clinical and office environment. The typical schedule is Monday through Friday, 8:00 AM to 4:30 PM, with one 10:00 AM to 6:30 PM shift each week, plus rotating weekends and holidays. The position is scheduled for 40 hours per week.

Requirements

At least 3 years of RN work experience.
Graduate from a nursing specialty training program.
Licensed Registered Nurse in Pennsylvania.
Basic Life Support certification.

Nice To Haves

Experience in case management, critical care, emergency care, or home healthcare.
Bachelor's degree in Nursing.

Responsibilities

Work with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge.
Monitor patient care through assessments and evaluations to ensure progress toward desired outcomes.
Assess and respond to patient and family needs by coordinating efforts of other team members.
Identify and resolve barriers that hinder effective patient care.
Work with physicians, nurses, interdisciplinary team members, and others to assess, plan, and initiate patient plans of care.
Facilitate and coordinate discharge details with appropriate agencies.
Facilitate and coordinate individualized care coordination plans.
Serve as a resource to physicians and hospital personnel about agency, facility, and community services available to assist with discharge planning.
Complete appropriate federal, state, and local forms.
Monitor quality of care using predetermined criteria, report potential risks and quality-management issues through defined processes, and enter data as appropriate to support quality improvement initiatives.
Conduct ongoing case reviews for delays or variances in care and raise issues with the appropriate department, attending physician, or physician designee.
Capture data according to department policy.
Communicate identified issues to the appropriate physician for resolution and intervention.
Use approved medical necessity criteria to assess whether patients meet appropriateness-of-setting requirements.
Involve the payer liaison in cases that may not meet medical necessity guidelines.
Support payer liaisons in resolving barriers through appropriate administrative and medical channels to avoid third-party payer denials.
Maintain awareness of concurrent denials through interaction with the payer liaison.
Work with the payer liaison to facilitate timely discharge or an alternative plan of care acceptable to the physician, family, and payer.

Benefits

Medical, dental, and vision benefits starting day one.
Three medical plan options, including expanded coverage for out-of-area employees and dependents.
401(k) with automatic Geisinger contributions.
Generous paid time off.
Up to $5,000 annually in tuition reimbursement.
Company-paid life and disability insurance.
Healthcare and dependent care flexible spending accounts and a health savings account.
MyHealth Rewards wellness incentives.
Family-focused benefits, including adoption and fertility assistance, parental leave pay, military leave pay, and Care.com membership.
Employee Assistance Program resources for mental health, work-life needs, legal guidance, and caregiving support.
Optional coverage for accident, critical illness, hospital indemnity, identity theft, pet care, legal needs, and more.