Nurse Case Manager, RN (Case Management)

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician‑owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources. HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Case Manager. Position Summary The role of the Nurse Case Manager is to engage members enrolled in case management to provide care coordination, education and a plan of care leading to improved health outcomes. Essential Position Functions / Responsibilities Responsible for telephonic case management, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develop a plan of care and course of action to address all issues and barriers. Provide care coordination for patients including chronic disease management/education and interdisciplinary collaboration while complying with policy and procedures and contractual and regulatory requirements. Develop and implement case management plans in collaboration with member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals. Establish appropriate timeframe and frequency for follow‑up, case closure, or referral for services as the member transitions through the continuum. Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Follow evidence‑based guidelines and contact standards to facilitate closure of gaps in care and encourage use of in‑network services. Apply clinical judgment to identify precipitating cause of admission to prevent hospital readmissions. Oversee all transition of care events to ensure continuity of care. Delegate and oversee Priority Care Coordinator activity. Consistently apply and/or interpret evidence‑based criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member needs. Assess for barriers to care, provide care coordination and assistance to member to address concerns. Present cases at interdisciplinary rounds to obtain a multidisciplinary perspective and recommendations to achieve optimal outcomes. Demonstrate accountability and skills in analysis, problem solving, decision making, time management, and oral and written communications. Facilitate interdisciplinary care team meetings and informal ICT collaboration. Display professionalism through good work habits as observed in all encounters. Use motivational interviewing to educate, support, and motivate change during member contact. Keep current with all standards, policies and procedures of HealthCare Partners and act as a resource to other staff members with necessary support. Review completed HRAs and Medication Reconciliations to determine need and preliminary stratification level for case management. Other related duties as required. Skills, Knowledge, Abilities Versed in use and application of MCG Guidelines. Knowledge of NCQA, Federal, State and other Regulatory requirements. Excellent verbal and written communication skills, expressing self in a clear, concise, and professional manner. Ability to work collaboratively and effectively with the interdisciplinary team members, patients, families, and external case managers. Skilled in managing competing priorities and deadlines while demonstrating the ability to effectively prioritize and manage multiple tasks. Excellent time management and organizational skills. Training / Education NYS RN license required. BSN preferred. Experience Previous experience in UM and case management/care coordination. Experience with patient/family education. Minimum of 2‑5 years healthcare experience in an acute setting. Base Compensation; $90,000 - $105,000 annually. HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Department: Clinical Services This is a non‑management position. This is a full time position. #J-18808-Ljbffr Health Care Partners