Hybrid Registered Nurse (RN) Care Manager - MLTC - Brooklyn

divh2Nurse Care Manager/h2pThe 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 members health needs while promoting quality cost effective outcomes./ppEssential Functions:/pulliEnsures consistent care along the entire health care continuum by assessing and closely monitoring members needs and status./liliAuthorizes covered services and coordinates care regardless of payer./liliCollaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team./liliWorks with member/family to maintain the most independent living situation possible/liliAssesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings./liliRegularly assesses members for ongoing eligibility for services based on the specific plans eligibility criteria./liliPerforms home visits as required to assess members living situation, cultural influences, functional and cognitive needs./liliCollaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member./liliEnsures appropriate, safe plan for members discharge from their plan./liliIdentifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy./liliIdentifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM)./liliResponds to members requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated/liliIdentifies 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./liliDocuments 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./liliDevelops 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./liliPerform any other job related duties as requested./li/ulpEducation and Experience:/pulliAssociates degree in Nursing from an accredited nursing program required/liliBachelors degree in Nursing preferred/liliThree (3) years of experience as a registered nurse required/liliClinical experience in geriatrics and/or managed long-term care experience preferred/liliExperience using multiple languages may be required based on operational needs/li/ulpCompetencies, Knowledge and Skills:/pulliIntermediate proficiency level with Microsoft Office, including Outlook, Word and Excel/liliAbility to communicate effectively with a diverse group of individuals/liliAbility to multi-task and work independently within a team environment/liliKnowledge of local, state federal healthcare laws and regulations all company policies regarding case management practices/liliAdhere to code of ethics that aligns with professional practice/liliKnowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice/liliStrong advocate for members at all levels of care/liliStrong understanding and sensitivity of all cultures and demographic diversity/liliAbility to interpret and implement current research findings/liliAwareness of community state support resources/liliCritical listening and thinking skills/liliDecision making and problem-solving skills/liliStrong organizational and time management skills/liliBilingual speaking and writing skills are preferred/li/ulpLicensure and Certification:/pulliCurrent, unrestricted Registered Nurse licensure in the state of New York required/liliCase Management Certification preferred/liliMust have valid drivers license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a drivers license record check. If the drivers license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated/li/ulpWorking Conditions:/pulliThis 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 members/liliOver 50% (Mobile) Routine travel required/li/ulpCompensation Range:/pp$100,000 - $135,000/ppCareSource takes into consideration a combination of a candidates education, training, and experience as well as the positions 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 employees total well-being and offer a substantial and comprehensive total rewards package./ppCompensation Type (hourly/salary):/ppSalary/ppOrganization Level Competencies:/pulliFostering a Collaborative Workplace Culture/liliCultivate Partnerships/liliDevelop Self and Others/liliDrive Execution/liliInfluence Others/liliPursue Personal Excellence/liliUnderstand the Business/li/ulpThis 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./p/div