Job Summary

Serves in an expanded clinical role to collaborate with patients, Primary Care Providers, community agencies, behavioral health, and other health plan departments to provide a model of care to maximize member’s health status. 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 Medicaid, Medicare and Commercial populations.

Job Duties

• Completes structured clinical assessments for identified patients.

• This requires knowledge of medical terminology, diagnostic criteria, and chart review.

• Designs an individualized plan of care with the member and fosters a team approach by working collaboratively with the member, family, primary care provider, and other members of the health care team to ensure coordination of services.

• Works closely with assigned primary care provider site and functions as a case manager for patients with behavioral health co-morbidities across the care team to develop and maintain positive working relationships with patients, families and providers.

• Implements clinical interventions based on risk stratification and evidence-based clinical guidelines in conjunction with the primary care provider or specialist.

• Contacts patients through written correspondence and telephone calls, and conducts follow-up interviews.

• Provides clinical oversight and guidance to team members.

• Participates in data collection, health outcomes reporting, clinical audits and programmatic evaluation related to government initiatives.

• In partnership with the care team, identifies patients at risk for poor outcomes or experiencing poor coordination of services who would benefit from more intensive follow up.

• Provides chronic disease and self-management education and support.

• Conducts in-home member assessments for high risk and complex patient cases.

• Develops collaborative relationships with community based agencies to improve care, services and access for Health Plan membership.

• Evaluates practices of self and colleagues against standards of practice and relevant regulations and acts to improve compliance.

• 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

• 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  

• Robust PTO plan in addition to six paid holidays and 32 hours of personal time per year 

• 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 

Education

Master's Degree-Related Field of Study (Required)

Experience

Minimum of 2 years-Clinical (Required)

Certification(s) and License(s)

Licensed Social Worker within 1 year - Default Issuing Body

Skills

Computer Literacy; Critical Thinking; Organizing

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Our Commitment to Diversity, Equity and Inclusion

Geisinger values who you are, where you are from, and where you are going. We seek out people of various backgrounds and cultures with unique abilities, non-traditional career paths and ambitious aspirations. 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. Read more about Our Commitment to Inclusive Recruiting.

Our Vision & Values

Everything we do is about making better health easier 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.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.