Nurse Case Manager II
SGS Consulting
Job Responsibilities:
- 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
- Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
- Provides evidence-based disease management education and support to help the member achieve health goals.
- Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.
- Provides care coordination to support a seamless health care experience for the member.
- Meticulous documentation of care management activity in the member’s electronic health record.
- Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
- Identifies and connects members with health plan benefits and community resources.
- Meets regulatory requirements within specified timelines.
Skills:
- 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.
- 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.
- Bilingual skills, especially English & Spanish
Education/Experience:
- Associates of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
- 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.
- Bachelor of Science in Nursing (BSN) (PREFERRED)
Vacancy posted more than 2 months ago
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