Registered Nurse (RN) - Care Manager

Job Description

Job Description

Job Title: Registered Nurse (RN) - Care Manager
Job Location: New York, NY 10004
Job Duration: 2- 3 Months (Possibility of extension)
Shift time: 9AM to 5PM , Hybrid
Pay Rate $65/hr. - $68/hr. on w2

Note: We have openings for Manhattan/ Brooklyn/ Bronx/ Queens (choose any location, shift, department as per experience)

Position Overview:
Role & Responsibilities:

• Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business.
• Develop a working relationship with the PCP to be able to contact and discuss the care of the member with them.
• Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team.
• Identify the risk factors and assign the risk category to the member.
• As part of Care Management team, develops a formal care plan for all services needed for the member, including the member’s disaster plan.
• Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary.
• Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
• Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care.
• Prior approve request for additional services based on assessments and using evidence-based standards refer denial, reduction, or limitation of service request to Medical Director.
• Assist members with the coordination of services both within and outside networks as appropriate. Includes facilitating discharge from acute setting and alternate settings.
• Provides Care Coordination through continuum of care.
• Optimizes both the quality of care and the quality of life for the members.
• Coordinate with Utilization Management (UM) department on concurrent and retrospective review.
• Follow up with assigned nurses for clinical updates to care plan.
• Document within two business day’s coordination notes and routine contacts with the members according to the level of risk assigned to them.
• Participate in team care planning meetings.
• Handles complains that can be resolved in one day
• Assists Customer Service and the UM department by providing records and materials needed for grievances from MLTC/MAP program members
• Speaks to members who are delinquent in their spend-down payments.
• Cooperates with all department within
• Identifies members appropriate for specialty programs.
• Performs all MLTC/MAP management activities in compliance with all regulatory agency requirements.
• Provides information on all requests from Quality Management Department to be reviewed by the various Quality committees.
• Completes all other tasks assigned by MLTC Department Leadership.
• Participates in the department on call schedule/being on call, which is rotated amongst the care team.

Skills:

• Minimum of five (5) years of clinical experience as a Registered Nurse
• Leadership experience preferred
• Experience in: Care Coordination, Utilization Review, Discharge Planning
• Computer literacy required
• Bilingual Spanish Certification in Case Management

Education & Licensure :

• Licensed Registered Nurse (RN) in the State of New York (required)
• Baccalaureate degree (required)
• PRI and Screen certification required within three (3) months of employment
• Preferred Qualifications: Master’s Degree.

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