RN - Utilization Case Manager Registered Nurse - Health Plan - Danville, United States - Geisinger

Description

Job Title: RN - Utilization Case Manager Registered Nurse - Geisinger Health Plan
Location: Danville, Pennsylvania
Job Category: RN - Registered Nurse, Nursing and Nursing Support, Geisinger Health Plan
Schedule: Days
Work Type: Full time
Department: GHP Post-Acute Care & Utilization Management Division
Date Posted: 05/21/2024
Job ID: R-62638

Job Summary

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.

Job Duties

• 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 healthcare team to ensure coordination of services.
• Continuously evaluates laboratory results, diagnostic tests, utilization patterns, and other metrics to monitor quality and efficiency results for the 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. Accountable for satisfying all job-specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.

Position Details

• Hours: 8 am to 4:30 pm
• Work from home: This position is primarily remote. Must be willing to travel for onsite meetings. Must be a Pennsylvania resident. Travel - Less than 25%
• Primary function: Review clinical criteria for services requiring prior authorization
• Required experience: 3 years of RN work experience
• Preferred Experience: Utilization Review/Utilization Management

Work from Home Internet requirements:

• Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service)

The minimum requirement is:

• 5 MBPS UP
• 20 Mbps DOWN
• <75 ms Ping Required
• <30ms Gitter Required

The computer must be connected to the internet via Ethernet cable; WiFi is not permitted unless a Virtual Private Network (VPN) is used for the WiFi connection

Geisinger values not only its patients and members but also you and your family. They offer a competitive compensation and benefits package to ensure that you and your loved ones can maintain good health, achieve financial stability, and excel personally and professionally. Geisinger believes in fostering a diverse and inclusive environment where all employees can be their true selves.

Benefits of working at Geisinger:

• 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 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

Education

Graduate from Specialty Training Program-Nursing (Required), Bachelor's Degree-Nursing (Preferred)

Experience

Minimum of 3 years-Nursing (Required)

Certification(s) and License(s)

Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania

Our Purpose & Values

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger families, and our communities. Kindness: Striving to treat everyone as we would hope to be treated ourselves. Excellence: Treasuring colleagues who humbly strive for excellence. Learning: Sharing knowledge with the best and the brightest to better prepare caregivers for tomorrow. Innovation: Constantly seeking new and better ways to care for our patients, our members, our community, and the nation. Safety: Providing a safe environment for our patients, members, and the Geisinger family. We offer healthcare benefits for full-time and part-time positions from day one, including vision, dental, and domestic partners. Encouraging collaboration, cooperation, and collegiality from senior management to all employees, we know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Geisinger is an affirmative action, equal opportunity employer, and all qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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