Healthcare - Case Manager V

UAS RNs Temp To Hire

Position Summary: Schedule will be M-F 8:30AM-5PM. Borough: 2. Bronx/ Westchester/ Manhattan temps will visit members in their homes, assisted living facilities and nursing homes. Daily responsibilities will be conducting UAS Assessments to support care management. Candidates will be assigned a minimum of 15 cases per week.

Essential Functions/Responsibilities:

• Conduct face to face assessments of members' functional status, medical, behavioral, psychosocial and community resource needs.
• Provides the Interdisciplinary Care Team (ICT) with assessment information and act as facilitator to ensure that members' needs are met.
• Develop an ICP/PCSP based on members' clinical, behavioral and social needs that addresses barriers to care.
• Competent assessment of members' health status and ensure that member is receiving all necessary medical and supportive services.
• Modify ICP/PCSP as appropriate to member's needs and progress.
• Manage care transitions through effective and timely communication necessary for member care and discharge planning.
• Clarifies SWH plan medical benefits, policies and procedures for members, providers and community-based agencies.
• Prepare for and participate in clinical case reviews to share best practices.
• Adhere to SWH documentation policies and procedures including documentation of clinical assessment activities and their effectiveness.
• Maintain a comprehensive working knowledge of community resources, payer requirements, and network services for target population.
• Collaborate with other SWH Care Managers to reduce variations in clinical practice, identify opportunities for systems' improvement, and develop policies and procedures relevant to practice.
• Provide backup to other Assessment nurses as needed.
• Analyze data and use it to improve care delivery.
• Performs other duties as assigned.

Skills/Aptitudes:

• Strong professional level of knowledge and comprehensive clinical assessment skills in the adult population and chronic disease management.
• Excellent communication skills.
• Strong computer skills: competent in Microsoft Office Products (Outlook, Word, Excel).
• Ability to work independently and maintain flexibly in fast paced environment.
• Ability to analyze data and use it to improve care delivery.
• Self-starter with high level of accountability and responsibility for outcome of care.
• Highly organized and able to manage multiple priorities appropriately.
• Independent problem solving skills.
• Able to work collaboratively and build enduring relationships with providers, members and the multidisciplinary team.

Summary: Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina member's progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines.

Required Education: Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Experience: 10+ years of clinical experience with case management experience.

Required Licensure/Certification: Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing. A combination of experience and education will be considered in lieu of LCSW or APSW. Must have valid driver's license with good driving record and be able to drive locally.