Care Manager Registered Nurse
Company: Geisinger
Location: Lewistown
Posted on: February 25, 2021
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Job Description:
Are you a RN looking to join our team of Healthcare Heroes?
Through professional growth, quality improvement, and
interdisciplinary collaboration, we?ve built an innovative culture
that allows nurses to grow their skillsets, develop their practice,
and leverage their years of experience to build a rewarding,
lasting career with impact. Our Geisinger nurses make a difference
in the lives of the people they see every day- our friends,
neighbors, and family members.Join our Geisinger Health Plan family
as a RN Care Manager. In this innovative role, you will have the
opportunity to work side by side with the Emergency Department
nursing and physician to directly impact a patient's diversion from
hospital admission by securing community based resources to manage
care safely and comfortably from a patient's home. Prior experience
working in an Emergency Room and Care Management preferred.Works
with physician and multidisciplinary team members to develop plan
of care for each assigned patient from admission through discharge.
Ensure patient is progressing towards desired outcomes by
continuously monitoring patient care through assessments and
evaluations. Assess and respond to patient and family needs by
coordinating efforts of other team members. Identifies and resolves
barriers that hinder effective patient care.* Works in conjunction
with physicians, nurses, inter disciplinary team and others to
assess, plan and initiate patient plan of care.* Facilitates and
coordinates details of the actual discharge to appropriate
agencies.* Facilitates and coordinates an individualized care
coordination plan.* Serves as a resource to physician and hospital
personnel regarding available agency, facility, and community
services to assist in discharge planning.* Completes appropriate
federal, state and local forms.* Ensures adherence to quality
standards and participation in quality monitoring and improvement
by monitoring quality of care using predetermined criteria,
reporting potential risk and quality management issues identified
from medical record review to appropriate departments through
defined processes, and enters data as requested and appropriate for
role, to support quality improvement initiatives into appropriate
system.* Conducts on-going case review for delays or variances in
care; raises issues with appropriate department, attending
physician and physician designee.* Captures data per department
policy.* Communicates to appropriate physician identified issues
for resolution and intervention.* Uses approved medical necessity
criteria as a tool to ensure that patients meet appropriateness of
the setting.* Actively involves payer liaison role in any case that
has potential of not meeting medical necessity guidelines.*
Supports payer liaison role to resolve barriers through appropriate
administrative and medical channels to avoid third party payer
denials.* Maintains awareness of all concurrent denials through
interaction with payer liaison.* Works with payer liaison to
facilitate timely discharge or alternative plan of care acceptable
to physician, family and payer.Work is typically performed in a
clinical and office 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.Graduate from Specialty Training
Program-Nursing (Required), Bachelor's Degree-Healthcare Related
Degree (Preferred)
Keywords: Geisinger, Reading , Care Manager Registered Nurse, Executive , Lewistown, Pennsylvania
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