Registered Nurse Care Manager

This is a fully remote position, open to applicants in New York.

📋 Description

• Provide care coordination, which includes in-home assessment, planning, facilitation, advocacy, and authorization of covered plan services.

• Evaluate and continuously monitor members' needs and status throughout the health care continuum.

• Authorize covered services and ensure care coordination irrespective of the payer.

• Collaborate with members, families, caregivers, primary care practitioners, and the interdisciplinary team.

• Assist members and families in achieving the most independent living situation possible.

• Manage ongoing care across hospital, sub-acute, long-term, and home environments.

• Assess ongoing eligibility for services based on specific plan criteria.

• Conduct home visits to evaluate living situations, cultural influences, and functional and cognitive needs.

• Work alongside the primary care physician and Inter-Disciplinary Team to create Patient Centered Service Plans.

• Ensure the development of safe and suitable member discharge plans.

• Identify, investigate, and document grievances occurring on the same day.

• Present complex care management cases during Intensive Care Management meetings.

• Address member requests within specified timeframes and complete Initial Adverse Determinations as necessary.

• Identify members who need Care Management Review and develop suitable care plans.

• Document care management and coordination in alignment with company and plan policies.

• Create efficient care plans, authorize necessary services at appropriate levels, collaborate with network providers, and ensure services meet members' needs.

• Perform additional related duties as requested.

⛳️ Requirements

• Associate degree in Nursing from an accredited nursing program is required.

• A minimum of two (2) years of experience as a registered nurse is required.

• Current, unrestricted Registered Nurse license in the state of New York is mandatory.

• Must possess a valid driver's license, a vehicle, and verifiable insurance.

• Successful completion of a driver's license record check is required.

• Annual Influenza vaccination is required for designated positions during the Influenza season.

• Intermediate proficiency in Microsoft Office, including Outlook, Word, and Excel, is necessary.

• Familiarity with local, state, and federal healthcare laws and regulations, as well as company case management policies, is essential.

• Knowledge of the Case Management Society of America (CMSA) standards for case management practice is important.

• Ability to interpret and apply current research findings is required.

• Awareness of community and state support resources is beneficial.

• Strong critical listening and thinking, decision-making, and problem-solving skills are essential.

• Excellent organizational and time management skills are required.

• Must reside within the assigned territory.

• May require travel exceeding 50% of the time.

• A Bachelor's degree in Nursing is preferred.

• Clinical experience in geriatrics and/or managed long-term care is preferred.

• Experience utilizing multiple languages may be necessary based on operational needs.

• Bilingual speaking and writing skills are preferred.

• Case Management Certification is preferred.

🏝️ Benefits

• Bonus opportunities linked to company and individual performance may be available.

• Comprehensive total rewards package is offered.

• Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs are available.

• Annual Influenza vaccination provided/required for designated positions during Influenza season.

• Flexible hours, including potential evenings and/or weekends as needed.