Hybrid RN Case Manager - Queens

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.
• Affects assessments, 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.
• Safely manages members’ discharge from their plan.
• Identifies same day grievances, investigates and documents accordingly.
• Documents any grievance according to plan policy.
• 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.
• 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.

Education And Experience

• Associates degree in Nursing from an accredited nursing program required.
• Bachelor's degree in Nursing preferred.
• Two (2) 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.

Competencies, Knowledge And 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 & 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.
• 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.

Licenses And Certifications

• Current, unrestricted Registered Nurse licensure in the state of New York required.
• Case Management Certification preferred.

Employment Incentives

• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position.
• CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.
• Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

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 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.

Salary Information

• $100,000 - $135,000

Salary Organization Level

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