RN - Registered Nurse Care Manager - Community Based

Geisinger•Pittston, PA

1d•Hybrid

About The Position

At Geisinger, you’ll find a supportive work culture, a comprehensive benefits package and now a newly enhanced pay structure – making it the perfect time to advance your careers with us. You as an RN Care Manager within Geisinger at Home will play a vital role in delivering patient-centered care to Geisinger Health Plan’s most complex members in a home-based setting. You'll work collaboratively with physicians, nurses, and an interdisciplinary care team to assess, plan, and implement individualized care plans that promote optimal health outcomes. Luzerne County will be your primary territory but may need to cover other areas as needed. This role will be to support home visits to patients in Luzerne County. The position involves working with physicians and multidisciplinary team members to develop and monitor patient care plans from admission through discharge, ensuring progress towards desired outcomes. It also involves assessing and responding to patient and family needs by coordinating team efforts, identifying and resolving barriers to effective patient care, and facilitating discharge to appropriate agencies. The role requires coordinating individualized care plans, serving as a resource for community services, completing necessary forms, and ensuring adherence to quality standards. The RN Care Manager will conduct ongoing case reviews, communicate issues to physicians, use medical necessity criteria, and work with payer liaisons to resolve barriers and facilitate timely discharge. The work is typically performed in a clinical and office environment, with a specific focus on home/community based care.

Requirements

Minimum of 3 years-Nursing
Graduate from Specialty Training Program-Nursing
Basic Life Support Certification
Licensed Registered Nurse (Pennsylvania)
Acts Decisively
Care Management Knowledge
Communication
Interpersonal Communication
Multitasking
Organizing
Teamwork

Nice To Haves

Prior nursing experience in an Emergency Department, ICU or Home Health environment
Bachelor's Degree-Healthcare Related Degree

Responsibilities

Play a vital role in delivering patient-centered care to Geisinger Health Plan’s most complex members in a home-based setting.
Work collaboratively with physicians, nurses, and an interdisciplinary care team to assess, plan, and implement individualized care plans that promote optimal health outcomes.
Support home visits to patients in Luzerne County.
Work 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.
Identify and resolve barriers that hinder effective patient care.
Work in conjunction with physicians, nurses, inter disciplinary team and others to assess, plan and initiate patient plan of care.
Facilitate and coordinate details of the actual discharge to appropriate agencies.
Facilitate and coordinate an individualized care coordination plan.
Serve as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning.
Complete appropriate federal, state and local forms.
Ensure adherence to quality standards and participation in quality monitoring and improvement by monitoring quality of care using predetermined criteria.
Report potential risk and quality management issues identified from medical record review to appropriate departments through defined processes.
Enter data as requested and appropriate for role, to support quality improvement initiatives into appropriate system.
Conduct on-going case review for delays or variances in care.
Raise issues with appropriate department, attending physician and physician designee.
Capture data per department policy.
Communicate to appropriate physician identified issues for resolution and intervention.
Use approved medical necessity criteria as a tool to ensure that patients meet appropriateness of the setting.
Actively involve payer liaison role in any case that has potential of not meeting medical necessity guidelines.
Support payer liaison role to resolve barriers through appropriate administrative and medical channels to avoid third party payer denials.
Maintain awareness of all concurrent denials through interaction with payer liaison.
Work with payer liaison to facilitate timely discharge or alternative plan of care acceptable to physician, family and payer.

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.
Healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.