Nurse Case Manager II

Description

Job Title

Nurse Case Manager

Location

New York

Position Description

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Roles Responsibilities

• Conduct telephonic visits using comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports (MLTSS). Perform in-person assessments for non-MLTSS members to determine medical needs and support appropriate service referrals (e.g., adult medical daycare, pediatric medical daycare, personal care assistant services, nursing facility custodial care, Personal Preference Program, and MLTSS enrollment).

• Work with diverse populations, including pediatric and medically complex members.

• Coordinate and collaborate with members, authorized representatives, primary care providers, and interdisciplinary care teams.

• Schedule and participate in interdisciplinary meetings, advocating for members to ensure safe transitions and appropriate services.

• Develop individualized care plans and authorize services within MLTSS/FIDE program benefits in a cost-effective manner.

• Document all assessments, interactions, and care planning activities accurately and in a timely manner in the electronic health record.

• Utilize strong critical-thinking and problem-solving skills in daily work.

• Mentor new staff once appropriate proficiency has been achieved.

Skills

• Active, unrestricted RN license in the state of New York.

• Minimum of 3 years of clinical experience in settings such as hospitals, home health, or ambulatory care.

• Experience in case management and/or discharge planning.

• Background in managed care.

• Crisis intervention skills.

Education

• Case Management Certification CCM preferred.

• Minimum of an associate degree in Nursing.

• Active and unrestricted RN license in the state of NY.