Job Title: Care Manager
Profession: Nursing
Specialty: Care Management
Duration: Full time
Shift: Monday to Friday
Hours per Shift: 9am - 5pm
Experience: Five years minimum of clinical experience as a Registered Nurse, leadership experience preferred, two to three years clinical experience in certified home health agency or managed long-term care preferred
License: RN License as a Registered Nurse in the State of New York required
Certifications: Baccalaureate degree required, PRI and Screen certification within three months of employment required, Master's Degree preferred
Must-Have:
- Care Management experience
- Computer literacy
Description:
The Care Manager develops, facilitates, monitors, and communicates a care plan in partnership with the member, their family or significant other, primary caregiver, the primary and/or attending physicians, and various providers.
Using the assessments and interviews conducted by the Assessment Nurse, the Care Manager identifies the risk factors, strengths, challenges, and service needs of the member as they strive to keep them safe and well in their community setting.
Review and evaluate assessments and relevant information for members.
Develop a working relationship with the Primary Care Physician (PCP) to discuss the care of the member.
Review assessment findings with the PCP to identify any concerns not previously addressed by the clinical team.
Identify risk factors and assign risk categories to members.
As part of the Care Management team, develop a formal care plan for all services needed by the member, including a disaster plan.
Monitor the condition of all members at least monthly, typically by phone but face-to-face when necessary.
Identify clinical issues requiring immediate assessment and/or treatment to reduce the risk of unnecessary hospitalizations or nursing home admissions.
Identify opportunities to improve the quality of care by ensuring members receive necessary preventive and chronic disease care.
Approve requests for additional services based on assessments and refer denials or limitations of service requests to a Medical Director.
Assist members in coordinating services both within and outside networks as appropriate.
Facilitate discharge from acute settings and alternate settings.
Provide Care Coordination through the continuum of care.
Optimize both the quality of care and the quality of life for members.
Coordinate with Utilization Management (UM) department on concurrent and retrospective reviews.
Follow up with assigned nurses for clinical updates to care plans.
Document coordination notes and routine contacts with members within two business days based on the level of risk assigned to them.
Participate in team care planning meetings.
Handle complaints that can be resolved within one day.
Assist Customer Service and the UM department by providing necessary records and materials for grievances.
Engage with members who are delinquent in their payments.
Cooperate with all departments.
Identify members appropriate for specialty programs.
Perform all management activities in compliance with regulatory agency requirements.
Provide information on all requests from the Quality Management Department for review.
Complete all other tasks assigned by leadership.
Participate in the department on-call schedule, which is rotated among the care team.