RN - Registered Nurse - Case Manager - GHP

Geisinger•Work from home (Pennsylvania), PA

6d•Remote

About The Position

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. At Geisinger Health Plan, you’ll be pioneering, pairing our health plan with a network of primary care and specialty providers, hospitals and urgent and convenient care centers. And it's all to make better health easier for our community. 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. In this RN Case Manager role you'll support our commercial population, helping members address their individual health needs while collaborating with internal teams to advance employer-focused population health strategies and initiatives.

Requirements

At least two (2) years of RN work experience is required.
Active RN license is required.
Computer Literacy
Critical Thinking
Organizing

Nice To Haves

Case management experience
Certified Case Manager / American Case Management Association (ACMA)
BSN
Knowledge of healthcare laws, regulations, and insurance coverage policies
Proficiency in healthcare IT systems and insurance claims processes
Ability to work autonomously and as part of a multidisciplinary team
Active compact RN license is a plus.

Responsibilities

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.

Benefits

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.