Compensation: $51,680.00 - $72,960.00 /year *
Employment Type: Full-Time
**JOB TITLE:** Case Manager, Medical Management **LOCATION:** Geisinger Centerpoint **DEPARTMENT:** Geisinger Health Plans **WORK SCHEDULE:** Days/Evenings **WORK TYPE:** Full Time **JOB SUMMARY:** Responsible for management of the precertification/prior authorization process on a 24/7 basis, as well as assessment and management of Health Plan Members admitted to acute and sub-acute care facilities, receiving Home Health Services, or seeking Determination of Coverage of benefits. The Professional will assure delivery of comprehensive, cost-effective, quality care, as well as appropriate allocation of medical resources. The Professional will assess, plan, implement, coordinate, monitor and evaluate all options and services to assure safe transitions of care that will support best outcomes for patients and their families. Performs duties to support the goals and objectives of Geisinger Health Plan in its effort to assure quality patient care in a cost-effective manner achieving a high level of patient satisfaction. to the Director of MM Operations, and receives direction from the Health Plan Medical Director team. **COMPETENCIES AND SKILLS:** Demonstrates strong clinical assessment skills and excellent communication, organization and time management skills. Demonstrates customer focused interpersonal skills to interact in an effective manner with physicians, the interdisciplinary health care team, community agencies, Members and families. Demonstrates the ability to function independently and effectively in a rapidly changing environment, as well as the ability to influence and negotiate individual and group decision-making processes. Demonstrates general computer knowledge, with proven keyboarding proficiency. **EDUCATION AND/OR EXPERIENCE:** For physical health case management review: Registered Nurse with current Pennsylvania license required. BSN or comparable Bachelor's degree preferred. Minimum of three years recent nursing experience to match responsibilities above such as acute care, home health, skilled nursing, or ambulatory care setting. Experience in critical care, emergency department, or medical/surgical nursing as well as a combination of adult and pediatric experience is preferred. Case Management or Utilization Management experience preferred, as well as knowledge of basic concepts and principles of managed care. Working knowledge of regulatory requirements, such as Medicare, Medicaid, Department of Labor, Department of Health, and Department of Insurance is also preferred. For behavioral health case management review: Master's Degree in Social Work (MSW) or Psychology (MS) from accredited school or program required LSW (Licensed Social Worker) LCSW (Licensed Clinical Social Worker), or LPC (Licensed Professional Counselor) with the Pennsylvania State Board preferred. Licensure required within 1 year of hire. Two (2) years of clinical social work experience or five (5) years of behavioral health work experience required. Case Management or Utilization Management experience preferred, as well as knowledge of basic concepts and principles of managed care. Working knowledge of regulatory requirements, such as Medicare, Medicaid, Department of Labor, Department of Health, and Department of Insurance is also preferred. Behavioral Health experience preferred **WORKING CONDITIONS/PHYSICAL DEMANDS:** Work is typically performed in an office setting or clinical setting. Requires valid Pennsylvania driver's license and a willingness to travel using company or personal vehicle. On-call coverage is part of this role **_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 at , Instagram at , LinkedIn at and Twitter at . ** 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.
Associated topics: business development, case manager, liaison, manage, office manager, plan, project, program management, project development, resource development
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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