Works 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 andfamily needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care.
Works in conjunction with physicians, nurses, inter disciplinary team and others to assess, plan and initiate patient plan of care.
Facilitates and coordinates details of the actual discharge to appropriate agencies.
Facilitates and coordinates an individualized care coordination plan.
Serves as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning.
Completes appropriate federal, state and local forms.
Ensures adherence to quality standards and participation in quality monitoring and improvement by monitoring quality of care using predetermined criteria, reporting potential risk and quality management issues identified from medical record review to appropriate departments through defined processes, and enters data as requested and appropriate for role, to support quality improvement initiatives into appropriate system.
Conducts on-going case review for delays or variances in care; raises issues with appropriate department, attending physician and physician designee.
Captures data per department policy.
Communicates to appropriate physicianidentified issues for resolution and intervention.
Uses approved medical necessity criteria as a tool to ensure that patients meet appropriateness of the setting.
Actively involves payer liaison role in any case that has potential of not meeting medical necessity guidelines.
Supports payer liaison role to resolve barriers through appropriate administrative and medical channels to avoid third party payer denials.
Maintains awareness of all concurrent denials through interaction with payer liaison.
Works with payer liaison to facilitate timely discharge or alternative plan of care acceptable to physician, family and payer.
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.
The RN Care Manager role allows nurses who are looking to transition away from the bedside to continue to use their nursing and critical thinking skills in a fast paced environment where no two days are ever the same. It is a challenging, yet rewarding role that gives you the opportunity to positively affect the lives of patients and families. You will be able to maintain a good work life balance and you will be surrounded by a supportive interdisciplinary team.
Hours: 8am to 4:30pm
Weekends/Holidays: Rotation based to be reviewed at interview
Certification: ACM certification within 2 years. Geisinger will assist with this.
At Geisinger, the caring that we provide to our patients and members also extends to you and your family. Our competitive compensation and benefits package helps you and your loved ones stay healthy, meet your financial goals and thrive professionally and personally.
Benefits: Geisinger offers a comprehensive suite of healthcare benefits, including medical, prescription drug, vision and dental coverage. And with our healthcare benefits, you'll also receive care from one of the top innovative healthcare systems in the country. Our suite of benefits supports you and your family in a variety of ways, including coverage for same-sex or opposite-sex spouses, domestic partners and their children and stepchildren.
Paid Time Off: Our generous paid-time-off packages allow you to take the time you need to travel, rest, and care for and reconnect with friends and family. We also offer paid military and parental leave.
Diversity and Inclusion: We strive to create an environment where our patients, health plan members and employees can be their most authentic selves. Join one of our many Employee Resource Groups (ERGs). ERGs provide opportunities for all Geisinger employees to build internal and external networks and further develop professionally. ERGs are formed around common identities but are open to all employees.
Tuition Assistance: Up to $5,000 tuition reimbursement: We offer tuition reimbursement towards both undergraduate and graduate degrees.(Part time and Full Time Positions only)
Retirement: We contribute 5% of your salary to your retirement plan and offer auto-enrollment to make saving convenient for you.
Graduate from Specialty Training Program-Nursing (Required), Bachelor's Degree-Nursing (Preferred)
Minimum of 3 years-Nursing (Required)
Certification(s) and License(s)
Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania
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 We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.