Hybrid Registered Nurse (RN) Care Manager - Brooklyn - R11935

Job Summary

The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.

Essential Functions

- Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status. - Authorizes covered services and coordinates care regardless of payer. - Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team. - Works with member/family to maintain the most independent living situation possible - Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings. - Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria. - Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs. - Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member. - Ensures appropriate, safe plan for members’ discharge from their plan. - Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy. - Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM). - Responds to members’ requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated - Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care. - Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes. - Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members’ needs. - Perform any other job related duties as requested.

Education and Experience

- Associates degree in Nursing from an accredited nursing program required - Bachelor's degree in Nursing preferred - Three (3) years of experience as a registered nurse required - Clinical experience in geriatrics and/or managed long-term care experience preferred - Experience using multiple languages may be required based on operational needs - Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel - Ability to communicate effectively with a diverse group of individuals - Ability to multi-task and work independently within a team environment - Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices - Adhere to code of ethics that aligns with professional practice - Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice - Strong advocate for members at all levels of care - Strong understanding and sensitivity of all cultures and demographic diversity - Ability to interpret and implement current research findings - Awareness of community & state support resources - Critical listening and thinking skills - Decision making and problem-solving skills - Strong organizational and time management skills - Bilingual speaking and writing skills are preferred - Current, unrestricted Registered Nurse licensure in the state of New York required - Case Management Certification preferred

Compensation Range

$100,000 - $135,000 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type

Salary

Competencies

- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business