Create a Job Alert.

Enter your email below to save this search and receive job recommendations for similar positions.
Thank you. We'll send jobs matching these to
You already suscribed to this job alert.
US
0 suggestions are available, use up and down arrow to navigate them
What job do you want?

Case Manager (RN) job in New York at The Execu | Search Group

Create Job Alert.

Get similar jobs sent to your email

List of Jobs

Apply to this job.
Think you're the perfect candidate?
Apply Now
Case Manager (RN) at The Execu | Search Group

Case Manager (RN)

The Execu | Search Group New York, NY Full Time
Apply Now
A New York City services organization is currently seeking a licensed Registered Nurse (RN) to join their team as their new Case Manager. In this role, the Case Manager (RN) will be responsible for assessing, planning and providing ongoing coordination and management of service delivery through an integrated case management approach.

Responsibilities:

The Case Manager (RN) will:
  • Provide comprehensive telephonic case management to targeted population who are at risk for admission and to medically complex patients to develop a tailored plan of care that supports the needs of the patients, influences adherence to treatment, assist with discharge planning and care coordination to ensure optimal outcomes
  • Communicate effectively with members, Physicians, and providers; facilitate, advocate, and educate on the disease process
  • Navigate within care management application and document management systems and maintain accurate documentation of case management assessment, planning, goals and interventions
  • Act as a Subject Matter Expert based on particular disease management areas of expertise: lead ongoing staff training, provide information regarding medications updates and continued education
  • Interpret reports, understand trends and target specific high risk population, provide recommendations, generate outcomes.
  • Promote active involvement and initiative to members regarding their health care management and navigating health care delivery systems in order to preserve benefit resources
  • Authorize vendor services using clinically proven criteria to make consistent care decisions
  • Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
  • Abide by and support the care management programs in order to ensure quality and efficient clinical operations
  • Perform additional duties and projects, as assigned by management

Qualifications:

  • 3+ years of Medical-Surgical experience; 2+ years of experience in a Case Management and/or Disease Management 
  • Bachelor's Degree in a related field
  • Valid NYS Registered Nurse (RN) license
  • Strong knowledge of Clinical evidence-based guidelines, industry standard Case Management criteria (Milliman Care Guidelines, Interqual), Medicare and Medicaid coverage guidelines, Health Claims processing, Medical Coding and interpreting provider contracts
  • Solid assessment, clinical, and documentation skills
  • Patient oriented
  • Great interpersonal skills
  • Excellent communication skills (written and verbal)
  • Strong attention to detail
  • Highly organized
Desired Skills:
  • Bachelor's Degree in Nursing
  • Certification in Case Management a plus
  • Knowledge of HEDIS, NCQA, and/or QARR

Recommended Skills

  • Attention To Detail
  • Care Coordination
  • Case Management
  • Certified Nurse Practitioner
  • Claim Processing
  • Clinical Works
Apply to this job.
Think you're the perfect candidate?
Apply Now

Help us improve CareerBuilder by providing feedback about this job:

Job ID: 238133

CareerBuilder TIP

For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.