Job Summary

Screens potential new enrollees and evaluates and coordinates new enrollees to the appropriate Case Management Program. Assists Case Team Staff with outreach activities to support care initiatives for members throughout the care continuum.

Job Duties

• Works with leadership to create appropriate support materials regarding program purpose, goals and objectives and deliverables.
• Meets with physicians across both Geisinger and the community to share details on the program.
• Identifies patients for recruitment and reviews with the appropriate primary and specialty care providers.
• Completes patient outreach and formal evaluation of all potential enrollees for the program to determine participant needs and eligibility for enrollment.
• Completes thorough review of all medical records including laboratory and radiology reports.
• Discusses care needs with primary or specialty care providers as needed.
• Interviews patient and family for in-home care needs as well as other behavioral or social gaps.
• Visits patients and families in their homes, at the hospital or nursing home for recruitment into program.
• Segments patients to the appropriate care team including home based medical team, community palliative care team or mobile integrated health team.
• Provides formal handoff to the appropriate care team.
• Schedules first visit with care team.
• Establishes and maintains an effective working relationship with County Area Agency on Aging and County Assistance Office delegates to provide a streamlined enrollment application process for Community Resources.
• Communicates with referral sources including physician offices, hospital discharge planning, and other community agencies for follow up in completion of the intake record.
• Provides follow up communication and correspondence to complete the enrollment process.
• Supports triage phone service taking acute care calls from patients and families or other care providers.
• Effectively assess acute care need.
• Manages gaps if able immediately.
• Identifies resources needed to respond to acute care need.
• Activates the correct care team or 9 as indicated by acuity of acute care need.
• Participates in weekly IDT meetings being prepared to share acute care activities for appropriate patients.
• Identified patterns to help the care team in Plan of Care adjustments.
• Maintains documentation of enrollment process, including prospective participants within designed software programs as necessary to complete mandatory state statistical reporting functions.
• Assists Administrative staff with completion of reporting requirements.

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: 7 am to 5:30 pm
• Weekends: Every other weekend
• Required experience: 1 year of RN work experience
• This position is onsite at Centerpoint in Pittston

Geisinger cares about not only its patients and members but also about you and your family. We offer a competitive compensation and benefits package to ensure that you and your loved ones can maintain good health, achieve financial stability, and excel both personally and professionally. We believe in creating a diverse and inclusive environment where all employees can be their authentic selves. To learn more: https://jobs.geisinger.org/diversity 

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  

Education

Graduate from Specialty Training Program-Nursing (Required)

Experience

Minimum of 1 year-Nursing (Required)

Certification(s) and License(s)

Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania

Skills

Interpersonal Communication; Organizing; Time Management; Group Problem Solving; Communication

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.