Hybrid Registered Nurse Care Manager - Bronx

CareSource Management Services•New York City, NY

1d•Hybrid

About The Position

The Nurse Care Manager provides care coordination, including in-home assessment, planning, facilitation, advocacy, and authorization of covered plan services to meet members’ health needs while promoting quality, cost-effective outcomes. The role supports members across the healthcare continuum and care settings, including hospitals, sub-acute and long-term care, and homes. It involves collaborating with members and their families or caregivers, primary care practitioners, and interdisciplinary teams to develop and implement appropriate care plans and promote the most independent living situation possible. This is a mobile position requiring routine travel to members’ homes and other work locations. The employee must reside in the assigned territory and may need to travel more than 50% of the time. Flexible hours, including possible evenings and weekends, may be required to serve members. The position requires a current, unrestricted New York RN license, a valid driver’s license, a vehicle, and verifiable insurance. Employment is conditional on acceptable driver’s license record review and compliance with the annual influenza vaccination requirement for designated positions.

Requirements

Associate degree in Nursing from an accredited nursing program.
At least two years of experience as a registered nurse.
Current, unrestricted Registered Nurse licensure in the state of New York.
Valid driver’s license, vehicle, and verifiable insurance; employment in the position is conditional on successful driver’s license record clearance.
Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel.
Ability to communicate effectively with a diverse group of individuals.
Ability to multitask and work independently within a team environment.
Knowledge of local, state, and federal healthcare laws and regulations, and company policies regarding case management practices.
Adherence to a code of ethics aligned with professional practice and to Case Management Society of America standards for case management practice.
Strong advocacy for members at all levels of care and sensitivity to cultures and demographic diversity.
Ability to interpret and implement current research findings.
Awareness of community and state support resources.
Critical listening and thinking, decision-making, problem-solving, organizational, and time-management skills.
Annual proof of influenza vaccination is required for designated positions during influenza season; employees hired during the season have 30 days from hire to complete the vaccination and verify immunization.
Must reside in the assigned territory.

Nice To Haves

Bachelor’s degree in Nursing.
Clinical experience in geriatrics and/or managed long-term care experience.
Experience using multiple languages, which may be required based on operational needs.
Bilingual speaking and writing skills.
Case Management Certification.

Responsibilities

Assess and closely monitor members’ needs and status to ensure consistent care across the healthcare continuum.
Authorize covered services and coordinate care regardless of payer.
Collaborate and communicate with members, families, caregivers, primary care practitioners, and the interdisciplinary team.
Work with members and families to maintain the most independent living situation possible.
Assess, plan, and provide continuous care management across hospital, sub-acute, long-term, and home settings.
Regularly assess members’ ongoing eligibility for services using the applicable plan’s eligibility criteria.
Conduct home visits as required to assess members’ living situations, cultural influences, and functional and cognitive needs.
Collaborate with the primary care physician and Inter-Disciplinary Team to develop each member’s Patient Centered Service Plan.
Ensure members have an appropriate and safe discharge plan.
Identify same-day grievances, investigate and document them, and follow plan policy.
Present members with complex care management needs or difficult-to-manage situations at Intensive Care Management meetings.
Respond to member requests within designated timeframes and complete Initial Adverse Determinations as indicated.
Identify members requiring Care Management Review, evaluate documentation from the IDT and hospital or nursing home discharge planners, and formulate an appropriate plan of care.
Document care management and coordination according to company policy and the member’s plan requirements, which may include monthly telephonic and in-person recertification notes.
Develop efficient plans of care, authorize only needed services at appropriate levels, use network providers, and ensure services are based on members’ needs.
Perform other job-related duties as requested.