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RN - Pediatric Registered Nurse Case Manager - HealthChoices - GHP

Job Summary

Geisinger Health Plan is making better health easier and more accessible. We are consistently ranked for outstanding care and coverage, not just by independent reviewers, but by our members, that tells you something. At Geisinger Health Plan, you’ll be pioneering, pairing our health plan with a network of primary care and specialty providers, hospitals and urgent and convenient care centers. And it's all to make better health easier for our community.

Job Duties

Join us in this RN Pediatric Case Manager role within HealthChoices 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.

• At least two (2) years of RN work experience is required.

• Certified Case Manager / American Case Management Association (ACMA) is required within 2 years of hire.

• 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.

• Full-time, exempt, days – work from home in the state of Pennsylvania.

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 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  

Position Details

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. 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.

Responsibilities