Registered Nurse Care Manager
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Job Description
Registered Nurse Care Manager coordinating assessments, authorizations, and care plans for CareSource members. Mobile role serving Brooklyn homes and care settings with extensive travel.
Responsibilities:
- Provide care coordination, including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services
- Assess and closely monitor members' needs and status across the health care continuum
- Authorize covered services and coordinate care regardless of payer
- Collaborate with members, families, caregivers, primary care practitioners and the interdisciplinary team
- Support members and families in maintaining the most independent living situation possible
- Manage continuous care across hospital, sub-acute, long-term and home settings
- Assess ongoing eligibility for services based on plan-specific criteria
- Perform home visits to assess living situations, cultural influences, and functional and cognitive needs
- Collaborate with the primary care physician and Inter-Disciplinary Team to develop Patient Centered Service Plans
- Ensure safe and appropriate member discharge plans
- Identify, investigate and document same-day grievances
- Present complex care management cases at Intensive Care Management meetings
- Respond to member requests within designated timeframes and complete Initial Adverse Determinations as indicated
- Identify members requiring Care Management Review and formulate appropriate plans of care
- Document care management and coordination according to company and plan policies
- Develop efficient plans of care, authorize needed services at appropriate levels, utilize network providers and ensure services meet members' needs
- Perform other related duties as requested
Requirements:
- Associate degree in Nursing from an accredited nursing program required
- Two (2) years of experience as a registered nurse required
- Current, unrestricted Registered Nurse licensure in the state of New York required
- Must have valid driver's license, vehicle and verifiable insurance
- Successful clearance of a driver's license record check required
- Annual Influenza vaccination required for designated positions during Influenza season
- Intermediate proficiency with Microsoft Office, including Outlook, Word and Excel
- Knowledge of local, state and federal healthcare laws and regulations and company case management policies
- Knowledge of Case Management Society of America (CMSA) standards for case management practice
- Ability to interpret and implement current research findings
- Awareness of community and state support resources
- Critical listening and thinking, decision-making and problem-solving skills
- Strong organizational and time management skills
- Must reside in the same assigned territory
- May be required to travel greater than 50% of the time
- Bachelor's degree in Nursing preferred
- Clinical experience in geriatrics and/or managed long-term care preferred
- Experience using multiple languages may be required based on operational needs
- Bilingual speaking and writing skills preferred
- Case Management Certification preferred
Benefits:
- Bonus tied to company and individual performance may be available
- Comprehensive total rewards package
- Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs
- Annual Influenza vaccination provided/required for designated positions during Influenza season
- Flexible hours, including possible evenings and/or weekends as needed
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