Description

HCA Solutions is currently seeking one qualified candidate to serve as a Case Manager RN and one candidate to serve as Adult Complex Case Manager RN for the Northwest (Erie, PA) region of the Medicaid expansion program for Geisinger Health Plan. Monday through Friday, 9am to 5:30pm, with limited weekend and holiday on-call. Position includes six paid holidays and PTO. Although this position is considered remote, candidate may travel up to 25% of the time within the indicated region, typically within a 45 minute one-way drive. ** MUST RESIDE IN PENNSYLVANIA** Bilingual candidates are preferred.

The Case Manager RN 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. 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.

Case Manager RN Job Description:

• 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 identified population.
• Develops systems of care that monitor progress and promote early intervention in acute care situations.
• Assists with the design, implementation, and evaluation of the advanced patient centered care model.
• Assesses the healthcare, educational and psychosocial needs of patients or members.
• 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.
• Maintains required documentation for all case management activities.
• Collects required data and utilizes this data to adjust the treatment plan when indicated.
• Travels occasionally to clients' homes or other clinics (25% of time)

Necessary KSAs for Case Manager RN:

• Computer Skills
• Critical Thinking
• Organizational Skills

Requirements

Case Manager RN requirements:

• Current, Unencumbered RN license for the state of Pennsylvania
• Current BLS certification
• Minimum three (3) years of Nursing experience
• Reliable Personal vehicle and Valid driver's license
• Bachelor's degree in Nursing, preferred
• Bilingual candidates are preferred.

All candidates must have the following previous to hire:

• COVID and Flu vaccines
• Single Tdap
• 2 Step Tuberculosis Skin Test
• Hepatitis B vaccine

Position requires High-speed Cable Modem-- no DSL, Wireless Cell, or Satellite

Position requires ACT 153 clearances- can be obtained prior to hire