Care Manager - ED

Duties:
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

Skills:
Five years minimum of clinical experience as a Registered Nurse. Leadership experience preferred. Experience with Care Coordination, Utilization review and discharge planning Computer literacy 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
Ability to work closely with members and
Ability to work collaboratively with various team members, interdepartmentally, and leadership

Education:
RN Licensed as a Registered Nurse in the State of New York required.
Baccalaureate degree required.
PRI and Screen certification within three months of employment is required. Master's Degree and Bilingual Spanish Certification in Case Management preferred.
Bachelors Degree 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).

Languages:
English

Certifications & Licenses:
Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED)