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:

Monday to Friday

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

Green Key Resources jobs

Remote Nurse Case Manager