Responsibilities Include:
- Develops and updates the individualized care plan based on a comprehensive assessment of members in consultation with the member and family/caregiver and the assessment nurse
- Implements the care plan and authorizes/arranges for delivery of covered services consistent with the care plan
- Conducts ongoing communication and collaboration with a member, family caregiver, or member's designated representative, as well as with member's PCP and other significant health care providers
- Monitors provision of services by network providers to ensure they are appropriate and in accordance with the member's care plan
- Conducts ongoing monitoring of member's health, safety, and functional status, and progress toward established goals
- Provides coordination of care transitions, including discharge and transition planning from the hospital or nursing homes
- Determines member eligibility for the company's program and quality initiatives; Facilitates the establishment of Advance Care Planning and assures appropriate administration of the member's Health Care Proxy
- Reviews member's medical status and issues, identifying follow-up issues
- Serves as primary contact with member's PCP or specialist physicians as well as member's long-term care service providers
- Monitors member's medication adherence in conjunction with the RN, Care Management Supervisor
- Provides education/coaching in self-management of disease processes
- Conducts monthly outreach to the member to check on member's status
- Updates member case records
- Participate in Quality Assurance and Improvement activities as directed by the Director of Care Management
- Other duties as assigned by the Care Management Supervisor and/or the Director of Care Management
Qualifications:
- Bachelor’s or Associates Degree in Nursing
- NEW YORK STATE NURSING LICENSE and located within the tri-state area
- Minimum of one-year experience in clinical practice, case management, care management, or home care
- Experience in managed care and/or care management preferred
- Experience with geriatric population preferred
#INDHCDH
Job Type: Full-time
Pay: $90,000.00 - $105,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
Application Question(s):
- Do you live in the New York Metropolitan Area?
Experience:
- Nursing: 2 years (Preferred)
- Case management: 1 year (Preferred)
License/Certification:
- NEW YORK STATE NURSING LICENSE (Required)
Work Location: Remote
