Position Summary:The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.Duties:50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.Provides evidence-based disease management education and support to help the member achieve health goals.Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.Provides care coordination to support a seamless health care experience for the member.Meticulous documentation of care management activity in the member’s electronic health record.Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.Identifies and connects members with health plan benefits and community resources.Meets regulatory requirements within specified timelines.The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.Conduct oneself with integrity, professionalism, and self-direction.Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.Familiarity with community resources and services.Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.Maintain strong collaborative and professional relationships with members and colleagues.Communicate effectively, both verbally and in writing.Experience :Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY. Additional licensure is preferred but not required. NY is not a compact state, single state licensure for NY is required.Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role. Will be trained on internal software and tools.Access to a private, dedicated space to conduct work effectively to meet The requirements of the position. Due to HIPPAA requirements the candidate must have a quiet area to work with no distractions.Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.Minimum 3+ years of nursing experienceMinimum 2+ years of case management, discharge planning and/or home healthcare coordination experienceExperience providing care management for Medicare and/or Medicaid members.Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.Experience conducting health-related assessments and facilitating the care planning process.Bilingual skills, especially English-Spanish, preferred but not requiredRequires an RN with unrestricted active licenseEducation:Associate’s of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)Notes:
Monday-Friday 8a-5p EST
Fully remote (never coming onsite)
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