RN Care Manager (DSNP)

Belong Health•New York, NY

12d•$80,000 - $95,000•Remote

About The Position

The Registered Nurse (RN) Care Manager for Belong Health's DSNP program is responsible for providing comprehensive, member-centered care management services for Medicare beneficiaries with complex medical, behavioral health, and social needs. This role applies care management principles to assess member needs, develop and implement individualized care plans, coordinate services across the continuum of care, and maintain collaborative relationships with provider practices, community-based organizations, caregivers, and the Belong Health team.

Requirements

Working knowledge of Medicare and Medicaid programs and experience with regulatory requirements and reporting
Proficient in navigating multiple systems; demonstrated PC skills using Microsoft applications
Two (2) or more years’ experience in a health plan, health care organization, Community Based Organization, or social services environment
Experience supporting Medicare, Medicare Advantage, Medicaid, Dual Eligible Special Needs Plans (DNP), or other complex populations
Experience delivering care management services in a telephonic and/or virtual environment
Understanding of needs and dynamics of elder care services, disadvantaged, disengaged populations
Knowledge of care coordination, transitions of care, motivational interviewing, and person-centered care planning principles
Experience participating in cross departmental projects and policy and procedure changes, including coordination of activities and initiatives across departments
Excellent customer service, active listening, issue assessment, trend identification, and analytical skills, with a demonstrated ability to problem solve effectively and efficiently
Commitment to high ethical standards in all work; protects the privacy of member and company data and exercises discretion in handling confidential member information
Excellent oral and written communication skills, including presentation skills
Strong organizational and follow-through skills
Demonstrated ability to manage a caseload of medically and socially complex members
Ability to work independently and effectively within a fully remote and highly collaborative team environment
Graduate of an accredited nursing program required
Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required
An active, unrestricted nursing license in the state of NY (RN)
Ability to obtain and maintain licensure in additional states if required by business needs

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred
Equivalent education and experience may be considered
Care Management Certification preferred
Bi-lingual Spanish speaking preferred
Care Management Certification preferred (CCM, ACM, CMGT-BC, or equivalent)

Responsibilities

Providing clinical oversight to medically complex Medicare beneficiaries
Orienting new members to the Belong Health DSNP program and educating the member and/or caregivers on care management services
Advocating, empowering, informing, and educating beneficiaries on self-management techniques
Conducting assessments to identify barriers and opportunities for intervention
Completing health risk assessments, reassessments, and other clinical evaluations in accordance with program requirements
Identifying members requiring intensive care management interventions and coordinating appropriate clinical, behavioral health and community-based services
Developing and implementing an individual care plan (ICP)
Monitoring member progress toward care plan goals and revising interventions based on changing clinical or social needs
Leading interdisciplinary care team meetings
Collaborating with provider, social workers, discharge planners, and community-based service providers to coordinate care and achieve care plan goals
Supporting transitions of care activities including post-discharge outreach, medication reconciliation support and coordination with providers and caregivers
Documenting all care management activities in the appropriate system in accordance with internal and established documentation procedures
Working directly with members, their families and/or advocates, providers, and community service organizations on an ongoing basis to coordinate care and reduce barriers to care
Utilizing population health, risk stratification and care management technology platforms to prioritize outreach and interventions
Promoting a culture of accountability and performance to both meet and exceed personal service vision goals and ensure timely and satisfactory resolution of highly complex, specialized, and non-routine customer issues
Other duties as assigned