RN - Registered Nurse - Complex Case Manager

Job Duties

• Will work with individuals who have complex health needs or multiple chronic conditions, often requiring a high level of coordination and support to manage their care. They focus on improving health outcomes, reducing hospital re-admissions, and ensuring patients receive appropriate and timely transitions of care.
• Will work closely with providers, the inter disciplinary team and other healthcare providers to ensure smooth transitions of care and effective communication.
• 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.
• Responsible for Care Without Delay Metrics and deploys specific readmission risk strategies to support patient 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 complex care patient population.
• Complex care manager works with Care Management Operations Team to stratify/ triage patients to the complex care team.
• Assesses the healthcare, educational and psychosocial needs of complex cases.
• 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.
• Coordinate care across different healthcare providers, services, and settings, ensuring a seamless transition of care.
• Educate patients and families on health conditions, self-management strategies, and available resources.
• Communicate effectively with healthcare providers, patients, families and other stakeholders to facilitate care coordination, including Skilled Nursing Home visits and collaboration.
• Advocate for patients and families on health conditions, self-management strategies, and available resources
• Maintains required documentation for all case management activities.
• Collects required data and utilizes this data to adjust the treatment plan when indicated.

Requirements

• Minimum of 3 years RN work experience required.
• Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania
• Work is typically performed in a clinical environment.

Qualifications

• Graduate from Specialty Training Program-Nursing (Required)
• Bachelor's Degree-Related Field of Study (Preferred)
• At least one year of RN Care Management is strongly preferred.
• ACMA accreditation is preferred and required within 3 years of hire.

Schedule

• Full-time, Exempt (salaried), Monday through Friday.
• This role will support multiple locations within the Geisinger system.

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

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

This response is AI-generated, for reference only.