Clinical - Senior Care Manager (RN)

Location : Remote-NY

Remote-NY

SHIFT : Mon - Fri 8 : 30 5 : 00, No OT Required

Duration : 3+ month, possible extension

Job Description : Position Purpose :

Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes.

Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families / care givers on services and benefit options available to receive appropriate high-quality care.

Education / Experience :

Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 6 years of related experience.

Walk me through the day to day responsibilities of this the role and a description of the project :

Will work with members on the phone to respond to completed assessments, falls, ER visits, hospitalizations, and enter authorizations for the members.

Describe the performance expectations / metrics for this individual and their team :

Depending on which pieces of care management we will have them do, we will set a daily expectation.

What previous job titles or background work will in this role?

Any home based RN experience

Internal / External Groups with which the Candidate will interface :

Required Skills / Experience :

Preferred Skills / Experience :

Organization

Home care experience is a bonus

Self driven to get the work done

Able to triage duties effectively

Good phone skills

Education Requirement :

NYS RN License

Education Preferred :

Software Skills Required :

Outlook, excel a plus

Required Certifications :

NYS RN license

Required Testing : none

none

License / Certification :

RN - Registered Nurse - State Licensure and / or Compact State Licensure required

For Illinois Youth Care Contract : Bachelor s degree in nursing requiredDevelops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and / or community resources needed to address member's unmet needs

Coordinates and manages as appropriate between the member and / or family / caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services

Monitors care plans / service plans and / or member status, change in condition, and progress towards care plan / service plan goals;

collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs

May identify problems / barriers for care management and appropriate care management interventions for escalated cases

Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations

Reviews referrals information and intake assessments to develop appropriate care plans / service plans

May perform telephonic, digital, home and / or other site outreach to assess member needs and collaborate with resources

Collaborates with healthcare providers as appropriate to facilitate member services and / or treatments and determine a revised care plan for member if needed

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

Provides and / or facilitates education to members and their families / caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits

Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner

May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness

Provides guidance and support to clinical new hires / preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice

Engages and assists New Hire / Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success

Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness

Other duties or responsibilities as assigned by people leader to meet business needs

Performs other duties as assigned

Complies with all policies and standards

Comments for Vendors :