Nurse Case Manager, RN (Case Management)

Nurse Case ManagerHealthCare 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 improve 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 barriersProvide care coordination for patients including chronic disease management/education and interdisciplinary collaboration while complying with policy and procedures and contractual and regulatory requirementsDevelop 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 continuumPerforms on-going monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordinglyFollow evidence based guidelines and contact standards to facilitate closure of gaps in care and encourage use of in network services.Applies clinical judgment to identify precipitating cause of admission to prevent hospital readmissionsOversees all transition of care events to ensure continuity of careDelegates and oversees Priority Care Coordinator activityConsistent application and/or interpretation of evidence based criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needsAssess for barriers to care, provides care coordination and assistance to member to address concernsPresents cases at interdisciplinary rounds to obtain a multidisciplinary perspective and recommendations to achieve optimal outcomesDemonstrated accountability and skills in analysis, problem solving, decision making, time management, and oral and written communicationsFacilitates interdisciplinary care team meetings and informal ICT collaborationDisplays professionalism through good work habits as observed in all encountersUses motivational interviewing to educate, support, and motivate change during member contactKeeps current with all standards, policies and procedures of HealthCare Partners and acts as a resource to other staff members with necessaryReviews completed HRAs and Medication Reconciliations to determine need and preliminary stratification level for case managementOther related duties as requiredQualification Requirements: Skills, Knowledge, AbilitiesVersed in use and application of MCG GuidelinesKnowledge of NCQA, Federal, State and other Regulatory requirementsExcellent verbal and written communication skills, expressing self in a clear, concise, and professional mannerAbility to work collaboratively and effectively with the interdisciplinary team members, patients, families, and external case managersSkilled in managing competing priorities and deadlines while demonstrating the ability to effectively prioritize and manage multiple tasksExcellent time management and organizational skillsTraining/Education:NYS RN license requiredBSN preferredExperience:Previous experience in UM and case management/care coordinationExperience with patient/family educationMinimum of 2-5 years healthcare experience in an acute settingOur website: HealthCare Partners Base Compensation: $90,000 - $105,000 annually Bonus Incentive: Eligibility based off organizational performance Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.) Equal Employment Opportunity Statement: HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Job Disclaimer: The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.