Nurse Case Manager II

Job Responsibilities:

• 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
• Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
• Provides evidence-based disease management education and support to help the member achieve health goals.
• Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.
• Provides care coordination to support a seamless health care experience for the member.
• Meticulous documentation of care management activity in the member’s electronic health record.
• Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
• Identifies and connects members with health plan benefits and community resources.
• Meets regulatory requirements within specified timelines.

Skills:

• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role.
• Minimum 3+ years of nursing experience
• Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience
• Experience providing care management for Medicare and/or Medicaid members.
• Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
• Experience conducting health-related assessments and facilitating the care planning process.
• Bilingual skills, especially English & Spanish

Education/Experience:

• Associates of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
• Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY. Additional licensure is preferred but not required. NY is not a compact state, single state licensure for NY is required.
• Bachelor of Science in Nursing (BSN) (PREFERRED)