Care Manager RN

Care Manager RNThe primary goal of the Care Manager is to optimize members' health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member's needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member's needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members' care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.Scope of Role & Responsibilities:Address member's problems and needs: clinical, psychosocial, financial, environmentalProvide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivationEngage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health to improve and maintain lifelong well beingPrepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practicesParticipate in interdisciplinary roundsEnsure plans of care have individualized goals and interventionsCommunicate plan of care to Primary Care PhysicianAddress gaps in care with the member and providerAddress members social determinants of health issuesLink members to available resourcesProvide care management support during Transitions of CareEnsure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriersTrain member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supportsAdvocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment optionsEmploy critical thinking and judgment when dealing with unplanned issuesMaintain knowledge of Chronic Conditions and use job aids as a guidanceMaintain accurate, comprehensive, and current clinical and non-clinical documentation in DCMS, the Care Management SystemComply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation processMaintain professional competencies as a Care ManagerOther duties as assigned by Manager.Required Education, Training & Professional Experience:Bachelor's Degree requiredMinimum 2 years' prior experience in a health care setting, Care Management, or Managed Care setting requiredAbility to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions requiredAbility to work closely with member and caregiver.Licensure and/or Certification 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).Professional Competencies (URAC Core 25b):Integrity and TrustCustomer FocusProficiency with computers navigating in multiple systems and web-based applicationsConfident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactiveStrong verbal and written communication skills including motivational coaching, influencing and negotiation abilitiesTime management and organizational skillsStrong problem-solving skillsAbility to prioritize and manage changing priorities under pressureMust know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.Ability to form effective working relationships with a wide range of individuals.