RN - Complex Case Manager - Care Coordination

The RN Complex Case Manager will work with individuals who have complex health needs or multiple chronic conditions, often requiring a high level of coordination and support to manage their care. They focus on improving health outcomes, reducing hospital re-admissions, and ensuring patients receive appropriate and timely transitions of care. Will work closely with providers, the inter disciplinary team and other healthcare providers to ensure smooth transitions of care and effective communication.

This role will support multiple locations within the Geisinger system. The role is full-time, Exempt (salaried), Monday through Friday. At least three (3) years of RN work experience is required. ACMA accreditation is preferred and required within 3 years of hire. At least one year of RN Care Management is strongly preferred.

• 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.
• Responsible for Care Without Delay Metrics and deploys specific readmission risk strategies to support patient 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 complex care patient population.
• Complex care manager works with Care Management Operations Team to stratify/ triage patients to the complex care team.
• Assesses the healthcare, educational and psychosocial needs of complex cases.
• 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.
• Coordinate care across different healthcare providers, services, and settings, ensuring a seamless transition of care.
• Educate patients and families on health conditions, self-management strategies, and available resources.
• Communicate effectively with healthcare providers, patients, families and other stakeholders to facilitate care coordination, including Skilled Nursing Home visits and collaboration.
• Advocate for patients and families on health conditions, self-management strategies, and available resources
• Maintains required documentation for all case management activities.
• Collects required data and utilizes this data to adjust the treatment plan when indicated.

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:

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) anda 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

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.