Care Manager Registered Nurse

Care Manager Registered Nurse

Job Ref: TE0108
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

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.

Required Education, Training and Profesional Experience 

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).

Professional Competencies 

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.

#LI-Hybrid

#MHP50