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.

Language Requirements: Chinese/ Spanish/ Bengali- PLEASE INDICATE ON RESUME WHICH LANGUAGES THE CANDIDATE SPEAKS

Required Experience: Management will accept ONLY: UAS Certified RN licensed in the state of NY New grads will be considered. Candidates with no UAS will be considered if they have experience with home care management.

Required Education: Bachelor's Degree or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Licensure/Certification: NY State RN License.

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/PCP 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/PCP 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.

Essential Functions:

• Provides case management services to members with chronic or complex conditions including:
• Proactively identifies members that may qualify for potential case management services.
• Conducts assessment of member needs by collecting in-depth information from Molina's information system, the member, member's family/caregiver, hospital staff, physicians and other providers.
• Identifies, assesses and manages members per established criteria.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
• Performs ongoing monitoring of the plan of care to evaluate effectiveness.
• Documents care plan progress in Molina's information system.
• Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
• Measures the effectiveness of interventions to determine case management outcomes.
• Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members.
• Conducts face to face or home visits as required.
• Maintains department productivity and quality measures.
• Manages and completes assigned work plan objectives and projects in a timely manner.
• Demonstrates dependability and reliability.
• Maintains effective team member relations.
• Adheres to all documentation guidelines.
• Attends regular staff meetings.
• Participates in Interdisciplinary Care Team (ICT) meetings.
• Assists orientation and mentoring of new team members as appropriate.
• Maintains professional relationships with provider community and internal and external customers.
• Conducts self in a professional manner at all times.
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
• Complies with required workplace safety standards.

Knowledge/Skills/Abilities:

• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Strong analytical skills.
• Knowledge of applicable state, and federal regulations.
• Knowledge of ICD-9, CPT coding and HCPC.
• SSI, Coordination of benefits, and Third Party Liability programs and integration.
• Familiarity with NCQA standards, state/federal regulations and measurement techniques.
• In depth knowledge of CCA and/or other Case Management tools.
• Ability to take initiative and see tasks to completion.
• Computer skills and experience with Microsoft Office Products.
• Excellent verbal and written communication skills.
• Ability to abide by Molina's policies.
• Able to maintain regular attendance based upon agreed schedule.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

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.