Case Manager, RN or Licensed Behavioral Health (SN LTSS)

About the role

The successful candidate will conduct case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards. They will identify members meeting program criteria, assess opportunities for education, support, coaching, and care coordination, and collaborate with interdisciplinary care teams to develop comprehensive care plans.

Responsibilities

• Handles physical health member clinical management programs.
• Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, and performs activities as directed by departmental policy and leadership.
• Carries out job responsibilities in compliance with departmental, corporate, state, federal, and accreditation standards.
• Maintains confidentiality and conducts information management procedures per corporate and departmental policy.
• Implements the Case Management Process per department policies, procedures, and guidelines.
• Screens members that fall within defined populations, referred to the department by data analysis or internal/external referral sources.
• Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services.
• Initiates case management, opens appropriate cases timely and effectively, and discloses essential information to members to increase the opportunity for success in meeting member health goals.
• Works in collaboration with members' physicians and other health care providers to assess needs, facilitate development of an interdisciplinary care plan, coordinate services, evaluate effectiveness, and modify the member care plan as necessary.
• Maintains positive working relationships within this arena.
• Assesses member/caregiver knowledge of their illness and initiates appropriate education interventions to address knowledge deficits.
• Collaborates with member/caregiver to determine specific objectives, goals, and actions to address member needs and barriers to meeting health goals identified during assessment.
• Provides appropriate resources and assistance to members with managing their health across the continuum of care.
• Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team.
• Acts as a liaison between providers and community resources.
• Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services.
• May work with internal and external stakeholders for value-based payment programs, such as accountable care organizations (ACO).
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• May participate in the orientation of new staff.

Requirements

• Associates degree required. Bachelor’s degree preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required; or LMSW; or LCSW; or LMHC.
• Minimum of three years of clinical experience required. Case Management experience preferred.
• Demonstrates proficiency with the Microsoft Office Suite.
• Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Delivers efficient, effective, and seamless care to members.

Qualifications

• Level I: Active NYS RN or Registered Dietician or Physical Therapist licensure required; or LMSW; or LCSW; or LMHC. Minimum of three years of clinical experience required. Case Management experience preferred. Demonstrates proficiency with the Microsoft Office Suite. Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred. Strong written and verbal communication skills. Ability to multitask and balance priorities. Delivers efficient, effective, and seamless care to members.
• Level II: A minimum of 2 years in case management position. Case Management Certification preferred. Demonstrates ability to escalate to management, as necessary. Demonstrates proficiency in all related technology and documentation requirements. Consistently meets or exceeds all performance metrics.
• Level III: Must have been in a current Case Management position or similar subject matter expert for at least 5 years. Case Management Certification required. Broad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems. Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues. Ability to lead the training of new staff. Demonstrated presentation skills.