Registered Nurse Care Manager

Nurse Care ManagerThe Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.Essential Functions:Ensures consistent care along the entire health care continuum by assessing and closely monitoring members' needs and status.Authorizes covered services and coordinates care regardless of payer.Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.Works with member/family to maintain the most independent living situation possibleAssesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.Regularly assesses members for ongoing eligibility for services based on the specific plan's eligibility criteria.Performs home visits as required to assess members' living situation, cultural influences, functional and cognitive needs.Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.Ensures appropriate, safe plan for members' discharge from their plan.Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).Responds to members' requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicatedIdentifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members' needs.Perform any other job related duties as requested.Education and Experience:Associates degree in Nursing from an accredited nursing program requiredBachelor's degree in Nursing preferredThree (3) years of experience as a registered nurse requiredClinical experience in geriatrics and/or managed long-term care experience preferredExperience using multiple languages may be required based on operational needsCompetencies, Knowledge and Skills:Intermediate proficiency level with Microsoft Office, including Outlook, Word and ExcelAbility to communicate effectively with a diverse group of individualsAbility to multi-task and work independently within a team environmentKnowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practicesAdhere to code of ethics that aligns with professional practiceKnowledge of and adherence to Case Management Society of America (CMSA) standards for case management practiceStrong advocate for members at all levels of careStrong understanding and sensitivity of all cultures and demographic diversityAbility to interpret and implement current research findingsAwareness of community & state support resourcesCritical listening and thinking skillsDecision making and problem-solving skillsStrong organizational and time management skillsBilingual speaking and writing skills are preferredLicensure and Certification:Current, unrestricted Registered Nurse licensure in the state of New York requiredCase Management Certification preferredMust have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminatedWorking Conditions:This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our membersOver 50% (Mobile) Routine travel requiredCompensation Range:$100,000 - $135,000CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.Compensation Type (hourly/salary):SalaryOrganization Level CompetenciesFostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.