Location: Geisinger Community Medical Center Work Schedule: Days Work Type: Full Time
Works under the supervision of the Regional Manager of Health Services and Director, Case Management.
Serves in an expanded nursing role to collaborate with members, their family and the Emergency Room team to provide a model of care that ensures the delivery of quality, efficient, cost-effective healthcare services and ensures that there is an appropriate discharge plan in place.
MAJOR DUTIES AND RESPONSIBILITIES:
Works with Health Services leadership in the design, implementation, and evaluation of a comprehensive case management model that optimizes value (high quality, optimal experience and efficiency).
Identifies the patients in the Emergency Room that are at highest risk and prioritize needs and direct interventions. Collaborates with the patient, family and Emergency Room team to ensure that the patient is able to access the services and treatment plan that is recommended.
Assesses the healthcare, educational and psychosocial needs of the member/family. Collaborates with the patient, family and Emergency Room team to design a discharge plan that meets the needs of the individual patient.
Collaborates with outpatient CM to ensure safe transition of care and follow with primary care physician. Coordinates referrals and other community resources in collaboration with the outpatient Case Manager and the Hospital Emergency Room Case Manager.
Collaborates with the hospital based Case Manager in arranging admissions to the appropriate level of care and coordinating discharge services.
Provides education to the patient and family to maximize the patients 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 population served by Geisinger Health Plan.
Manages utilization and practice metrics to further refine the delivery of care model to maximize clinical, quality, and fiscal outcomes.
Develops systems of care that monitor member progress and promote early intervention in acute care situations.
Works effectively with other members of the health care team to optimize interventions.
Assesses plans, implements, coordinates, monitors and evaluates all options and services with the goal of optimizing the members health status.
Implements clinical interventions based on risk stratification and evidenced-based clinical guidelines. Collaborates with primary care providers to enhance evidence-based clinical guideline adherence and promote best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up and monitoring as needed. Coordinates appropriate laboratory and diagnostic testing.
Implements systems of care that facilitate close monitoring of high-risk members to prevent and/or intervene early during acute exacerbations as well as manage members through all transitions of care (eg. from hospital to home or hospital to skilled nursing home, etc.).
Provides 24x7 On-call coverage, as assigned.
Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results..
Works closely with Medical Management to appropriately apply member benefits and serves as a resource to the member and healthcare team.
Adheres to GHP Administrative standards and HIPAA rules and regulations regarding member confidentiality.
Maintains required documentation for all case management activities. Collects required data and utilizes this data to adjust the treatment plan when indicated.
Works with Health Services leadership to continuously evaluate process, identify problems, and propose process improvement strategies to enhance case management operating activities.
Reviews the current literature regarding effective engagement and communication strategies, case management strategies, and behavior change strategies and incorporates into clinical practice.
Incorporates excellent written, verbal, and listening communication skills, positive relationship building skills, and critical analysis skills into case management practice.
Utilizes appropriate conflict resolution, assertiveness, negotiation, and collaboration skills in facilitating member throughout the health care continuum.
Performs duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform.
COMPETENCIES AND SKILLS:
Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural ideals.
Demonstrates ability to work autonomously and be directly accountable for practice including quality, clinical and financial outcomes.
Demonstrates ability to influence and negotiate individual and group decision-making.
Demonstrates ability to function effectively in a fluid, dynamic, and remain flexible in a rapidly changing environment.
Demonstrates leadership qualities including time management, verbal and written communication skills, listening skills, problem solving and decision-making, priority setting, work delegation and work organization.
EDUCATION AND/OR EXPERIENCE:
RN license or eligible for licensure in the state of Pennsylvania required. Bachelors degree in health care preferred.
Obtain Case Management Certification within 3 years.
Minimum of three to five years experience in clinical nursing required. Prior case management experience preferred. Knowledge of the basic concepts and principles of managed care required.
Critical thinking skills and ability to analyze complex data sets required. General computer knowledge and capability to use computers required.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment. Travel required.
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.