Nurse Case Manager - NICU (NY RN)

About the role

The Case Manager will focus on empowering members’ families to support optimal wellness while advocating for the necessary medical services across the healthcare continuum. Working in a telephonic managed-care setting, the Case Manager combines strong clinical knowledge and critical thinking to facilitate a plan of care that ensures quality medical care for the high-risk member population, following CMSA national standards for case management practice.

Responsibilities

• Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.
• Completes needs assessments for all members in Case Management and develops care plans individualized to each member’s needs, per ProgenyHealth policies and procedures.
• Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess the plan of care.
• Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits.
• Interfaces with providers to assist with care coordination activities, including appointments, transportation, and durable medical equipment (DME).
• Provides education to members regarding their condition, treatment plan, benefits, services, and how to access needed care.
• Monitors ongoing progress toward goal achievement and reassesses changes in health status throughout the continuum of care.
• Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure services are delivered and meet the member’s needs.
• Participates in interdisciplinary and client rounds with pertinent healthcare team members to identify, clarify, and/or prevent risk, quality, or plan-of-care variances.

Requirements

• Registered Nurse (RN) with a current, unrestricted license in New York State.
• Three or more years of clinical experience in a Level III or above NICU.
• CCM certification required within the timeframe specified by company policy.
• Experience with data entry into a database or EHR; must be computer literate.
• Excellent communication skills and organizational ability; must be self-motivated and willing to learn multiple tasks.
• Must be well organized, able to prioritize tasks, and demonstrate accuracy in spelling and documentation.
• Demonstrated strength in working independently as well as collaboratively within a team.
• Excellent interpersonal skills, telephone etiquette, and a commitment to maintaining positive communication at all times.
• Commitment to excellence in customer service.

Qualifications

• Preferred: EST or CST time zone.
• College degree is preferred.
• Experience in a Case Management role is preferred.

Benefits

• Paid Time Off
• Paid Parental Leave
• Medical, dental, and vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Professional development opportunities
• Business Casual work environment