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Geisinger

Integrated health system with hospitals

Registered Nurse - Intake Coordinator, Hospital at Home

Medical, Clinical & VeterinaryPosted on Nov 11
Full-timeNo salary listed

About the Job

Requirements

  • At least one year of nursing experience is required.
  • Graduation from a nursing specialty training program is required.
  • A Pennsylvania Registered Nurse license is required.
  • The role requires communication, group problem-solving, interpersonal communication, organizing, and time-management skills.

Responsibilities

  • Screen potential new enrollees and evaluate and coordinate them to the appropriate Case Management Program.
  • Assist Case Team staff with outreach activities supporting care initiatives for members throughout the care continuum.
  • Work with leadership to create support materials about program purpose, goals, objectives, and deliverables.
  • Meet with physicians within Geisinger and in the community to share program details.
  • Identify patients for recruitment and review them with the appropriate primary and specialty care providers.
  • Conduct patient outreach and formal evaluations of potential enrollees to determine their needs and eligibility for program enrollment.
  • Review medical records, including laboratory and radiology reports.
  • Discuss care needs with primary or specialty care providers as needed.
  • Interview patients and families about in-home care needs and behavioral or social gaps.
  • Visit patients and families at home, in the hospital, or in a nursing home for program recruitment.
  • Assign patients to the appropriate care team, including the home-based medical team, community palliative care team, or mobile integrated health team.
  • Provide a formal handoff to the appropriate care team and schedule the first care-team visit.
  • Maintain working relationships with County Area Agency on Aging and County Assistance Office delegates to streamline enrollment applications for community resources.
  • Communicate with referral sources, including physician offices, hospital discharge planning, and community agencies, to follow up on completion of intake records.
  • Provide follow-up communication and correspondence to complete the enrollment process.
  • Support the triage phone service by taking acute-care calls from patients, families, and other care providers.
  • Assess acute-care needs and address gaps immediately when possible.
  • Identify resources needed to respond to acute-care needs and activate the appropriate care team or emergency services according to acuity.
  • Participate in weekly interdisciplinary team meetings and report acute-care activities for appropriate patients.
  • Identify patterns that can inform care-team plan-of-care adjustments.
  • Document the enrollment process, including prospective participants, in designated software programs as needed for mandatory state statistical reporting.
  • Assist administrative staff with reporting requirements.

About the Company

Geisinger

Integrated health system with hospitals

Geisinger Health System runs hospitals and clinics across several locations, offering a wide range of medical services (from cancer and cardiology to pediatrics and women’s health) along with patient support tools like the MyGeisinger patient portal. Its main product is integrated health care: Geisinger provides medical treatment through its doctors, nurses, and facilities, and supports care with online access, remote telemedicine, and access to medical records and billing. Geisinger differentiates itself by combining clinical care with research and education in one system, including programs like MyCode health genetics research and ongoing clinical trials, plus direct links between patient care, research, and community health initiatives. The company’s goal is to improve health outcomes for patients by delivering coordinated care, advancing medical knowledge through research, and engaging with communities to support healthy living.

Company size
51-200
Company stage
Not listed
Total funding
Not listed
Headquarters
Danville, IL
Founded
1915

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