RN Care Manager

Elderwood•Buffalo, NY

4d•Hybrid

About The Position

In the role of an RN Care Manager, you are a critical resource for our members as you are responsible for assessing a member’s home health and level of care needs, assisting them in accessing necessary covered services, providing referrals and coordinating other medical services in support of their member centric service plan. The RN Care Manager also assists our members with obtaining needed medical, social, educational, psychosocial, financial, and other services, irrespective of whether the needed services are covered Elderwood Health Plan. You will partner with the Social Worker to facilitate the MLTC care model by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life. The RN Care Manager partners with the Social Worker to facilitate the MLTC care model by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life.

Requirements

At minimum, a current New York State Registered Nurse License and a valid NYS Driver’s license
Must have current knowledge of comprehensive case management, chronic care and geriatric issues, and best practices.
Minimum of three (3) years nursing experience in home care, case management, discharge planning or managed care
Minimum of one (1) year experience working with a frail or elderly population
Minimum one year experience with health assessments
Demonstrated favorable interpersonal and assessment skills.
Ability to identify patterns, connections and underlying themes that lead to understanding and resolving complex problems or situations.
Ability to focus on specific disease processes/health issues and identify strategies to promote client focused care planning
Familiarity with provisions of governmental and accrediting agency health plan requirements.
Familiar with applying clinical criteria when determining medical necessity and/or benefit administration.
HIPPA Privacy
Must possess computer skills, including working knowledge of Electronic Medical Records (EMR), Microsoft Office Suite (365)
Ability to meet established productivity goals.
Must have a safe driving record and dependable car, as well as willingness to travel throughout the EHP service area & perform day travel w/in assigned geographic areas. A DMV motor vehicle report will be reviewed.
Must be in good standing with the Medicare and Medicaid programs. This includes a criminal background check.
Possess good speaking and listening skills.

Nice To Haves

BSN, AAS Degree or diploma in Nursing and Case Management Certification is preferred
Bilingual skills are preferred, but not required.

Responsibilities

Provide a care management process of assessment, planning, facilitation, and advocacy for options and services to meet a member’s home health needs through collaboration, communication, and available resources, while promoting quality cost-effective outcomes.
Perform comprehensive (physical, emotional, psychosocial, and environmental) assessments in the Member’s home to assess potential enrollees’ appropriateness for Managed Long-Term Care (MLTC), or to reassess a member’s status and needs.
Developing and maintaining of a person-centered service plan based on a needs’ assessment identifying the strengths, capacities, preferences and long-term goals of the Member, resources available to meet member needs and ongoing revisions to the service plan based on the changes in the Member’s condition and status
Participating in the utilization review process and evaluating to determine if the member’s condition and needs meet criteria for covered services and provide service prior authorization or denials to health care providers
Review financial, legal, or medical issues and refer Members to social work or other professionals for estate planning, living wills, family trust, crisis services, and other programs
Ensure that documentation in the care management record meets all applicable professional standards, using an EMR for each observation, verbal report, or interaction with the Member, Member’s caregiver/family, PCP or other provider, whether by home visit, telephonic, or written interaction
Early identification of incipient problems or significant changes in Member conditions to initiate early intervention and strategies to prevent or more quickly treat chronic care exacerbations
Participate in Disease Management, Utilization Management, and Quality Improvement activities.
Competently use the UAS-NY assessment tool. Previous UAS-NY is desired, but not required. Training is available.
Use of standard patient assessment instruments such as PRI, UAS-NY