CARE MANAGER - NURSING

JOB PURPOSE:

Responsible for overall care management and quality of care for participants. Uses specialized discipline-specific knowledge to review assessments of field staff and coordinate a holistic care plan that addresses all domains of care. Provides care coordination in a manner that is sensitive to age, gender, sexual orientation, cultural, linguistic, racial, ethnic, religious backgrounds, and congenital or acquired disabilities.

JOB RESPONSIBILITIES:

• Participates and represents their discipline in the care planning meetings or as necessary.
• The Care Manager will review all discipline-specific documentation for quality and addresses any deficiencies with the field staff following disciplinary steps established by the Discipline Policy.
• Monitor how field staff is documenting all interventions with the participants and address/document any issue observed with the employee.
• Conduct coaching sessions with field staff as needed.
• The Care Manager (CM) communicates with the discipline-specific field staff regularly to coordinate a continuum of care consistent with the Member’s health care needs and goals. This care plan supports the Member in attaining and maintaining an optimal functional and health status.
• In coordination with the IDT, arranges, coordinates, and authorizes the provisions of appropriate services to meet identified member-specific needs (such as assistance with the Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), housing, home-delivered meals, and transportation) and when approved by the IDT, may authorize a range and number of community-based services.
• Implements specific care management activities and interventions that lead to accomplishing the participant’s goals.
• Provides care management services across sites and collaborates with appropriate team members, facility, discharge planner, and home care coordinator when members are transitioned between care settings.
• Documents services in accordance with CLHC standards and federal/state regulations.
• Coordinates, facilitates, and arranges for long-term care services in nursing homes, rehab facilities, etc. as needed.
• Collaborates with PCP and other Specialty physicians and specialty-based services and members of IDT regarding any changes in participant’s condition to secure, arrange and coordinate all resources for implementing optimal care.
• Provides or arranges for ongoing Skilled services, service authorization, and periodic assessment reassessment and evaluation of services.
• Monitors care management activities, services, and members’ responses to interventions, to determine the effectiveness of the plan of care and the utilization of services and implements changes and adjustments to meet needs and resolve goals.
• Evaluates the effectiveness of the plan of care in reaching desired goals and outcomes, makes modifications or changes in the plan of care based on changes in the member’s health, as needed.
• Fiscally responsible for providing services based on members’ needs.
• Maintains up-to-date knowledge about current health-related issues, procedures, evidence-based clinical practice guidelines, medications, and impacting health and practice standards.
• Conduct competencies, and training sessions with field staff as needed.
• Recommends and contributes to improvements in services, programs, policies, and procedures to ensure optimum care and services to members.
• Follows the organization’s policies regarding disciplinary action. Engages Human Resources as needed for guidance on disciplinary actions and terminations.
• Only act within the scope of the individual’s authority to practice.
• Meet a standardized set of competencies for the specific position description established by the PACE organization before working independently.
• Acting member of the IDT.
• All other duties as assigned.

Schedule: 8:00AM – 5:00PM

Weekly Hours: 40

Location: Remote (within 2 hrs commute range)

QUALIFICATIONS:

Education: Graduated from a Nursing education program acceptable to New York State Education Department (NYSED). Bachelor's degree preferred.

Experience:

• Minimum of two (2) years of Care Planning Experience.
• Minimum of two (2) years of administrative experience in a management capacity in a certified home health agency (CHHA), long-term home health care (LHCSA), acute care, medical-surgical, and/or critical care, nursing home experience, diagnostic & treatment clinic preferred.
• Customer Service experience required.
• Managed long-term care insurance experience beneficial.
• Minimum of one (1) year of experience working with a frail or elderly population or, if the individual has less than one (1) year of experience but meets all other requirements, must receive appropriate training from the PACE organization on working with a frail or elderly population upon hiring.
• Supervisory experience preferred.

License : Current active and unrestricted license and registration in New York State required.

Additional Requirements:

• Be legally authorized (for example, currently licensed, registered, or certified if applicable) to practice in the State in which the healthcare professional will perform the function.
• Be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.

Language: Bilingual preferred.

Physical Requirements

Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to:

• Standing – Duration of up to 6 hours a day.
• Sitting/Stationary Positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.
• Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and ability to lift patients safely and using OSHA guidelines, etc.
• Bending/Squatting – Must be able to safely bend or squat to care for patients, use medical supplies, etc.
• Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas Position requires the individual to be able to travel, and walk between sites/locations and work areas throughout the day.
• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools (ie. typing, use of medical supplies, equipment, etc.)
• Sight/Visual Requirements – Must be able to visually assess patients, read orders type/write documentation, etc. with accuracy.
• Audio Hearing and Motor Skills (Language) Requirements – Must be able to listen attentively and document information from patients, community members, providers, etc., and intake information through audio processing with accuracy. In addition, must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.
• Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max):

Every application is reviewed by our recruitment team. We do not use AI to make hiring decisions or automatically reject applicants. All employment decisions are based on job-related qualifications and applicable employment laws.