Registered Nurse – Case Manager

Job Description:

• Support the commercial population by helping members address individual health needs
• Collaborate with internal teams on employer-focused population health strategies and initiatives
• Assess, plan, implement, coordinate, monitor, and evaluate options and services to optimize patient or member health
• Manage utilization and practice metrics to refine care delivery and maximize clinical, quality, and fiscal outcomes
• Integrate evidence-based clinical guidelines, preventive guidelines, protocols, and metrics into patient-centric treatment plans
• Develop systems of care that monitor progress and promote early intervention in acute care situations
• Assist with the design, implementation, and evaluation of the advanced patient-centered care model
• Assess healthcare, educational, and psychosocial needs of patients or members
• Design individualized plans of care and coordinate services with patients, families, primary care providers, and healthcare teams
• Evaluate laboratory results, diagnostic tests, utilization patterns, and other metrics
• Apply benefits and utilization management while serving as a resource to patients, members, and healthcare teams
• Maintain documentation for case management activities
• Collect data and adjust treatment plans when indicated

Requirements:

• At least two (2) years of RN work experience
• Graduate from Specialty Training Program-Nursing (Required)
• Licensed Registered Nurse (Pennsylvania) required
• Bachelor's Degree-Nursing preferred
• Case management experience preferred
• Certified Case Manager / American Case Management Association (ACMA) preferred
• Knowledge of healthcare laws, regulations, and insurance coverage policies preferred
• Proficiency in healthcare IT systems and insurance claims processes preferred
• Ability to work autonomously and as part of a multidisciplinary team helpful
• Active compact RN license a plus
• Computer literacy
• Critical thinking
• Organizing

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 with a financial incentive
• Adoption and fertility assistance
• Parental leave pay
• Military leave pay
• Free Care.com membership with discounted backup care
• Employee Assistance Program (EAP), including childcare, eldercare, pet care referrals, free legal guidance, mental health visits, work-life support, and digital self-help tools
• Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life insurance, pet insurance, and legal insurance
• Healthcare benefits for full-time and part-time positions from day one, including vision, dental, and domestic partners