About this role
Role Overview
- Join us in this RN Pediatric Case Manager role in Geisinger Health Plan and support our vision to make better health easier for everyone while working within a collaborative environment designed to set you up for success.
- 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. Work is typically performed in a clinical environment.
Requirements
- At least two (2) years of RN work experience is required.
- Certified Case Manager / American Case Management Association (ACMA) is required within two (2) years of hire date.
- BSN is preferred.
- Strong pediatric nursing experience is highly preferred.
- Case management experience is preferred.
- Knowledge of pediatric 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.
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.