Care Manager Registered Nurse

Care Manager Registered Nurse

Job Ref: TE0108 Category: Utilization Review and Case Management Department: CASE MANAGEMENT Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: 112351.00 - 112351.00

The primary goal of the Care Manager is to optimize members health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the members needs, environment, providers, support system, and optimization of services available to them. Care Manager is expected to assess and evaluate members needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members care team, a plan of care with individualized goals and interventions is developed, implemented, and outcomes evaluated.

Scope of Role and Responsibilities:

• Address members problems and needs: clinical, psychosocial, financial, environmental.
• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation.
• Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health to improve and maintain lifelong well-being.
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices.
• Participate in interdisciplinary rounds.
• Ensure plans of care have individualized goals and interventions.
• Communicate plan of care to Primary Care Physician.
• Address gaps in care with the member and provider.
• Address members social determinants of health issues.
• Link members to available resources.
• Provide care management support during Transitions of Care.
• Ensure member/caregiver understanding as it relates to language barriers, stress reaction, or cognitive limitations/barriers.
• Train member on relevant chronic diseases, preventive care, medication management, medication reconciliation, and adherence, home safety, etc.
• Provide Complex care management including but not limited to ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports.
• Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options.
• Employ critical thinking and judgment when dealing with unplanned issues.
• Maintain knowledge of Chronic Conditions and use job aids as guidance.

Required Education, Training, and Professional Experience:

• Bachelors Degree required.
• Minimum 2 years prior experience in a health care setting.
• Care Management or Managed Care setting required.
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports, and prescriptions required.
• Ability to work closely with member and caregiver.
• Maintain accurate, comprehensive, and current clinical and non-clinical documentation in DCMS, the Care Management System.
• Comply with all orientation requirements, annual, and other mandatory trainings, organizational, and departmental policies and procedures, and actively participate in evaluation process.
• Maintain professional competencies as a Care Manager.
• Other duties as assigned by Manager.

Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED).

Professional Competencies:

• Integrity and Trust
• Customer Focus
• Proficiency with computers, navigating in multiple systems, and web-based applications.
• Confident, autonomous, solution-driven, detail-oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient, and proactive.
• Strong verbal and written communication skills, including motivational coaching, influencing, and negotiation abilities.
• Time management and organizational skills.
• Strong problem-solving skills.
• Ability to prioritize and manage changing priorities under pressure.
• Must know how to use Microsoft Office applications including Word, Excel, PowerPoint, and Outlook.
• Ability to form effective working relationships with a wide range of individuals.

LI-Hybrid MHP50