Hybrid Registered Nurse (RN) Care Manager - Manhattan - MLTC

Provides care coordination including in-home assessment, planning, facilitation, advocacy, and authorization of covered plan services to meet members’ health needs while promoting quality, cost-effective outcomes.

Responsibilities

• 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 an 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.
• Performs any other job-related duties as requested.

Requirements

• Associate 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.

Skills

• 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, and federal healthcare laws and regulations, and all company policies regarding case management practices.
• Adherence 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 and 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.

Licensure and Certification

• Current, unrestricted Registered Nurse licensure in the state of New York required.
• Case Management Certification preferred.
• Must have a valid driver’s license, vehicle, and verifiable insurance.
• Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employment has started, it will be terminated.

Working Conditions

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices, or other public settings, is essential.
• Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
• Must reside in the same territory they are assigned to work in; exceptions may be considered due to business need.
• May be required to travel greater than 50% of the time to perform work duties.
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer.
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members.
• Over 50% mobile; routine travel required.

Pay

$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.

Benefits

We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.