Care Manager Registered Nurse

The primary goal of the Care Manager is to optimize members' health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member's needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member's needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members' care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.


Scope of Role and Responsabilities

• Address member's problems and needs: clinical, psychosocial, financial, environmental
• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
• Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health to improve and maintain lifelong well being
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
• Participate in interdisciplinary rounds
• Ensure plans of care have individualized goals and interventions
• Communicate plan of care to Primary Care Physician
• Address gaps in care with the member and provider
• Address members social determinants of health issues
• Link members to available resources
• Provide care management support during Transitions of Care
• Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
• Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
• Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
• Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
• Employ critical thinking and judgment when dealing with unplanned issues
• Maintain knowledge of Chronic Conditions and use job aids as a guidance
• Bachelor's Degree required
• Minimum 2 years' prior experience in a health care setting, Care Management, or Managed Care setting required
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
• Ability to work closely with member and caregiver.
• Maintain accurate, comprehensive, and current clinical and non-clinical documentation in DCMS, the Care Management System
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
• Maintain professional competencies as a Care Manager
• Other duties as assigned by Manager.

• Bachelor's Degree required
• Minimum 2 years' prior experience in a health care setting, Care Management, or Managed Care setting required
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
• Ability to work closely with member and caregiver.
• Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED).

• Integrity and Trust
• Customer Focus
• Proficiency with computers navigating in multiple systems and web- based applications
• Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
• Time management and organizational skills
• Strong problem-solving skills
• Ability to prioritize and manage changing priorities under pressure
• Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
• Ability to form effective working relationships with a wide range of individuals.