RN Case Manager
JOB SUMMARY:
Job Title: RN Case Manager - Behavioral Health Care Coordination
Department: Medical Management
Reports To: Assistant Director, Behavioral Health
Position Summary:
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:
- Performs initial, concurrent and retrospective reviews, and evaluates and pre-authorizes requests for collateral services (home care/transportation) to ensure timely access to appropriate levels of care and enhance potential for favorable member outcomes in accordance with department guidelines and regulatory mandates.
- Provides outreach, care coordination and ongoing follow-up services for at-risk members in order to support timely access to care, efficient utilization of network and community resources, optimal coordination of behavioral health and collateral services, enhanced member self-management and sustained engagement in community-based care.
- 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.
- 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.
- Assists in emergency call response triage. Conducts telephonic safety assessment and follows protocols for emergency response as needed. 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 of stay and utlization of resources.
Education Requirements:
Bachelor’s degree in Nursing
Other Requirements (License, Certificate, Other):
NY State RN License.
Work Experience:
At least 2 years of clinical and behavioral health case management experience with demonstrated ability to make contributions to patient-focused care.
Technical Skills:
Position requires intermediate Excel/ Word and advanced 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.
- Must be able to apply nursing processes and systems theory to problem-solving activities.
- Good writing and excellent telephone assessment skills essential.
- Position works at 100 Church Street in lower Manhattan with opportunity to telecommute from home when presence at 100 Church Street 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 by using the following link:
https://www9.ultirecruit.com/HFM1000/jobboard/NewCandidateExt.aspx?__JobID=4038
For consideration apply online at www.healthfirstny.org
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