Location:Work from home (Pennsylvania)Shift:Days (United States of America)Scheduled Weekly Hours:40Worker Type:RegularExemption Status:YesJob Summary: Health Plan is making better health easier and more accessible.

We are consistently ranked for outstanding care and coverage, not just by independent reviewers, but by our members, that tells you something.

At Health Plan, you’ll be pioneering, pairing our health plan with a network of primary care and specialty providers, hospitals and urgent and convenient care centers. And it's all to make better health easier for our community.Job Duties:

Join Health Plan as an RN Case Manager and make a meaningful impact through patient-centered care coordination. In this rewarding role, you'll support our vision of making better health easier while working alongside a collaborative team that is invested in your success, growth, and ability to deliver exceptional outcomes.

In this RN Case Manager role you'll support our commercial population, helping members address their individual health needs while collaborating with internal teams to advance employer-focused population health strategies and initiatives.

• At least two (2) years of RN work experience is required.
• Case management experience and Certified Case Manager / American Case Management Association (ACMA) is preferred.
• BSN is preferred.
• Knowledge of healthcare laws, regulations, and insurance coverage policies, and proficiency in healthcare IT systems and insurance claims processes preferred.
• Ability to work autonomously and as part of a multidisciplinary team is helpful.
• Active compact RN license is a plus.
• A typical schedule is full-time, days.
• This role is Exempt/salaried.

Benefits of working at :

• Full benefits (health, dental and vision) starting on day one
• Three medical plan choices, including an expanded network for out-of-area employees and dependents
• Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA)
• Company-paid life insurance, short-term disability, and long-term disability coverage
• 401(k) plan that includes automatic contributions
• Generous paid time off (PTO) plan that allows you to accrue time quickly
• Up to $5,000 in tuition reimbursement per calendar year
• MyHealth Rewards wellness program to improve your health while earning a financial incentive
• Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay and a free Care membership with discounted backup care for your loved ones
• Employee Assistance Program (EAP): Referrals for childcare, eldercare, & pet care. Access free legal guidance, mental health visits, work-life support, digital self-help tools and more.
• Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life and pet and legal insurance.

Position Details:

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.

• 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.

Work is typically performed in a clinical 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.

Education:Graduate from Specialty Training Program-Nursing (Required), Bachelor's Degree-Nursing (Preferred)Experience:Minimum of 2 years-Nursing (Required)Certification(s) and License(s):Licensed Registered Nurse (Pennsylvania) - RN_State of PennsylvaniaSkills:Computer Literacy, Critical Thinking, Organizing

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our 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.
• SAFETY: We provide a safe environment for our patients and members and the 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, we encourage an atmosphere of collaboration, cooperation and collegiality.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.