RN Care Manager, Case Management Job in New York 10007, New York Us
JOB SUMMARY:
Job Title: RN Case Manager
Department: Medical Management
Reports To: Manager, Spectrum
Position Summary:
The RN Case Manager plans and manages patient care with members, their families or significant others, and coordinates with the PCP, SCP and all members of the health care team to facilitate the patient's care across continuums of care episodes.
Essential Duties and Responsibilities:
- Contributes to the development of patient-focused care and initiates the process in accordance with established guidelines. Conducts assessments, develops treatment plans, performs defined interventions, and generates referrals to providers, community-based resources and appropriate social services.
- Assesses member's physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including attending practitioner, utilization review staff, discharge planners, social workers, and coordinates care accordingly.
- Functions as a clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage length utilization and coordination of resources.
- Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments.
- Evaluates and pre-authorizes request for inpatient/outpatient, specialty care, home care, DME, and transportation services from network and out-of-network providers in accordance with departmental guidelines.
Other Duties and Responsibilities:
Documents all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to ensure integrity of member services provided over the continuum of care and over time.
Education Requirements:
Bachelor's degree in Nursing
Other Requirements (License, Certificate, Other):
NY State RN License.
Work Experience:
At least 2 years of clinical case management experience with behavioral health involvement with a demonstrated ability to make contributions to patient-focused care
Technical Skills:
Position requires intermediate Excel and advanced Word/Outlook skills.
Physical Demands:
Position constantly sits and keys; and occasionally reaches, stands, bends and walks. Must be able to occasionally lift/carry and push/pull up to 10lbs. Position requires repetitive use of both hands.
Work Environment:
Candidate constantly works in an indoor environment.
Additional Information:
- Must have knowledge of the concepts and philosophy of case management, utilization review regulations, and relevant medical standards of practice; as well as be able to apply nursing processes and systems theory to problem-solving activities. Good writing and excellent telephone assessment skills essential.
- Position works at 25 Broadway with opportunity to telecommute from home when presence at 25 Broadway is not needed for training and/or meetings.
Conditions of Employment:
Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.
Disclaimer:
The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status.
Requirements:
Please apply online using the following link:
https://www9.ultirecruit.com/HFM1000/jobboard/NewCandidateExt.aspx?__JobID=4186
For consideration apply online at www.healthfirstny.org
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