Care Manager RN

Care Manager RN

Job Ref: TE0215
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $112,351.00 - $112,351.00

Position Overview 

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 members’ 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 & Responsibilities

Provide care management support during transitions of care.

Complete transitions of care assessment to identify member needs.

Complete medication reconciliation.

Address members' clinical, psychosocial, financial, environmental, and social determinants of health needs.

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 plans of care with members, caregivers, and health care providers,

integrating concepts of cultural sensitivity and privacy practices

Participate in interdisciplinary rounds

Ensure plans of care include individualized goals and interventions

Communicate plans of care to primary care physicians and other members of the care team.

Address gaps in care with the members and providers

Address members social determinants of health issues

Link members to appropriate community and organizational resources.

Provide care management support during Transitions of Care

Ensure member and caregiver understanding by addressing language barriers, stress reactions, cognitive limitations, and other obstacles to care.

Educate members and caregivers on chronic disease management, preventive care, medication adherence, medication reconciliation, home safety, and other relevant health topics.

Provide complex/comprehensive 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 sound judgment when addressing unplanned issues and complex situations.

Maintain knowledge of chronic conditions and utilize job aids and clinical resources as appropriate.

Maintain accurate, comprehensive, and current clinical and non-clinical documentation in the Care Management Systems

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 Leadership

Required Education, Training & Professional Experience

Bachelor’s Degree required.

Minimum 2 years of care management experience in a healthcare setting or in a managed care organization.

Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required.

Ability to work closely with members and caregivers.

Ability to work collaboratively with various team members, interdepartmentally, and leadership.

Licensure and/or Certification Required

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).

Professional Competencies

Integrity and Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication

#MPH50

#LI-Hybrid