RN Case Manager- REMOTE

Job Description

Job Description

Here are the job details for your review:

Job Title: Nurse Case Manager II

Duration: 6+ Months Contract (Potential for extension)
Location: Remote-NY

Pay Rate:$44.12/ HR on W2
Shift Hours: M-F 8am-5pm

Put city, state and zip at tope of resumes

Screen shot of unrestricted license at the top of resume.

Must have an active RN license in the state of NY with no history or hits

Key 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.

Summary

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Required Qualifications
Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY. Additional licensure is preferred but not required. NY is not a compact state, single state licensure for NY is required.
Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role.
Access to a private, dedicated space to conduct work effectively to meet The requirements of the position.
Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
Minimum 3+ years of nursing experience
Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience
Experience providing care management for Medicare and/or Medicaid members.
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
Experience conducting health-related assessments and facilitating the care planning process.

Preferred Qualifications
Experience in case management and/or discharge planning
Background in managed care
Crisis intervention skills

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. Requires an RN with unrestricted active license