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.
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
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
Great interpersonal skills
Excellent communication skills (written and verbal)
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Job ID: 238133
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