The RN Care Manager, as part of an interdisciplinary team, including physicians, and payers, ensures that the patients progression through the acute episode of care (admission to post discharge) is quality driven, while being efficient and cost effective.
The RN Care Manager works with the attending and consulting physicians to facilitate effective and efficient transition through the process of hospitalization. The RN Care Manager works collaboratively with all members of the inter disciplinary team to ensure patient needs are met, and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted.
The RN Care Manager seeks the expertise of social workers to resolve psychosocial/financial patient care issues and to develop and implement complex patient transition/discharge plans as needed. The incumbent interacts with patients, family members, healthcare professionals, community, and state agencies in this effort.
The RN Care Manager serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The RN Care Manager is responsible for maintaining hospital compliance with regulatory bodies (e.g., CMS, PRO), as appropriate to their role and scope of responsibilities.
The RN Care Manager is knowledgeable of third party payer requirements, utilizes medical necessity criteria as a tool to assess appropriateness of level and setting of care, assists in the denial and appeals process, assesses quality and identifies and reports potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job.
The incumbent is responsible for participation in patient safety, performance improvement initiatives appropriate to the position. The incumbent conducts all job responsibilities according to the Mission and Values of the Hospital and organization.
The RN Care Manager reports to the Director of Care Management.
COMPETENCIES AND SKILLS:
Demonstrates the ability to work independently.
Demonstrates excellent verbal and written communication skills, critical thinking and problem solving skills, and the ability to prioritize well.
Demonstrates the ability to act in an autonomous, self directed manner.
Demonstrates the ability to receive stimuli from multiple sources simultaneously.
Demonstrates organization and delegation skills, negotiation and conflict resolution skills, demonstrates flexibility, and is committed to the team concept.
Demonstrates teamwork, initiative, and willingness to learn. Accepts and respects diversity without judgment, and possesses strong customer service values.
EDUCATION AND/OR EXPERIENCE:
Registered Nurse with a valid, unrestricted State license required.
Bachelors degree in Nursing or related health field preferred.
Three years of RN clinical or acute care experience; additional three to five years of experience required if nursing education not at the Bachelors degree. Certification in case management and or utilization review is required within three years of hire.
Care management knowledge and experience, particularly across the continuum preferred.
Payer case management, utilization management, or disease management experience preferred.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in a clinical office or patient setting.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
OUR PURPOSE & VALUES: Everything we do is about caring 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.
ABOUT GEISINGER: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. 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.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.