Nurse Case Manager II

Max bill rate ***
Put city, state and zip at tope of resumes
Screen shot of unrestricted license at the top of resume.
Must hav ean active RN license in the state of NY with no history or hits
Key Responsibilities
Conduct telephonic visits using comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports (MLTSS). Perform in-person assessments for non-MLTSS members to determine medical needs and support appropriate service referrals (e.g., adult medical daycare, pediatric medical daycare, personal care assistant services, nursing facility custodial care, Personal Preference Program, and MLTSS enrollment).
Work with diverse populations, including pediatric and medically complex members.
Coordinate and collaborate with members, authorized representatives, primary care providers, and interdisciplinary care teams.
Schedule and participate in interdisciplinary meetings, advocating for members to ensure safe transitions and appropriate services.
Develop individualized care plans and authorize services within MLTSS/FIDE program benefits in a cost-effective manner.
Document all assessments, interactions, and care planning activities accurately and in a timely manner in the electronic health record.
Utilize strong critical-thinking and problem-solving skills in daily work.
Mentor new staff once appropriate proficiency has been achieved.
Required Qualifications
Active, unrestricted RN license in the state of New York.
Minimum of 3 years of clinical experience in settings such as hospitals, home health, or ambulatory care.
REQUIRED: MUST BE FLUENT ON ENGLISH/SPANISH ( WRITTING, READING, SPEAKING)
Preferred Qualifications
Experience in case management and/or discharge planning
Background in managed care
Crisis intervention skills
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license


Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures


Position Summary:


The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.


Requires an RN with unrestricted active license


Duties:


Key Responsibilities


Conduct telephonic visits using comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports (MLTSS). Perform in-person assessments for non-MLTSS members to determine medical needs and support appropriate service referrals (e.g., adult medical daycare, pediatric medical daycare, personal care assistant services, nursing facility custodial care, Personal Preference Program, and MLTSS enrollment).
Work with diverse populations, including pediatric and medically complex members.
Coordinate and collaborate with members, authorized representatives, primary care providers, and interdisciplinary care teams.
Schedule and participate in interdisciplinary meetings, advocating for members to ensure safe transitions and appropriate services.
Develop individualized care plans and authorize services within MLTSS/FIDE program benefits in a cost-effective manner.
Document all assessments, interactions, and care planning activities accurately and in a timely manner in the electronic health record.
Utilize strong critical-thinking and problem-solving skills in daily work.
Mentor new staff once appropriate proficiency has been achieved.


Experience:


Required Qualifications
Active, unrestricted RN license in the state of New York.
Minimum of 3 years of clinical experience in settings such as hospitals, home health, or ambulatory care.


Preferred Qualifications
Experience in case management and/or discharge planning
Background in managed care
Crisis intervention skills


Education:


Case Management Certification CCM preferred
Minimum of an associate degree in Nursing
Active and unrestricted RN license in the state of NY