Geisinger Health System - Mifflintown, PA
posted 3 months ago
The RN - Registered Nurse Case Manager for the Special Needs Unit and Community Services at Geisinger Health Plan is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating all options and services aimed at optimizing the health status of patients or members. This role is crucial in managing utilization and practice metrics to refine the delivery of care models, ensuring maximized clinical, quality, and fiscal outcomes. The RN will integrate evidence-based clinical guidelines, preventive guidelines, protocols, and other metrics to develop patient-centric treatment plans that promote quality and efficiency in healthcare delivery for the identified population. In this position, the RN will develop systems of care that monitor patient progress and promote early intervention in acute care situations. They will assist in designing, implementing, and evaluating advanced patient-centered care models. The RN will assess the healthcare, educational, and psychosocial needs of patients or members, designing individualized care plans while fostering a collaborative team approach with patients, families, primary care providers, and other healthcare team members to ensure coordinated services. Continuous evaluation of laboratory results, diagnostic tests, and utilization patterns will be essential to monitor quality and efficiency results for the assigned population. The RN will also work to appropriately apply benefits and utilization management, serving as a resource for patients or members and the healthcare team. Maintaining required documentation for all case management activities and collecting necessary data to adjust treatment plans when indicated are also key responsibilities. The work is typically performed in a clinical environment, and the RN is accountable for satisfying all job-specific obligations and complying with organizational policies and procedures.