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Job description
Hybrid Registered Nurse Care Manager - MLTC - Bronx
nApply (
nremote type
nMobile
nlocations
nBronx, NY
ntime type
nFull time
nposted on
nPosted 19 Days Ago
njob requisition id
nR13727
nJob Summary:
nThe Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.
nEssential Functions:
nnnEnsures consistent care along the entire health care continuum by assessing and closely monitoring members' needs and status.
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nnAuthorizes covered services and coordinates care regardless of payer.
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nnCollaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
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nnWorks with member/family to maintain the most independent living situation possible
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nnAssesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
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nnRegularly assesses members for ongoing eligibility for services based on the specific plan's eligibility criteria.
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nnPerforms home visits as required to assess members' living situation, cultural influences, functional and cognitive needs.
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nnCollaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
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nnEnsures appropriate, safe plan for members' discharge from their plan.
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nnIdentifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.
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nnIdentifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
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nnResponds to members' requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated
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nnIdentifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.
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nnDocuments care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.
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nnDevelops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members' needs.
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nnPerform any other job related duties as requested.
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n nEducation and Experience:
nnnAssociates degree in Nursing from an accredited nursing program required
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nnBachelor's degree in Nursing preferred
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nnTwo (2) years of experience as a registered nurse required
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nnClinical experience in geriatrics and/or managed long-term care experience preferred
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nnExperience using multiple languages may be required based on operational needs
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n nCompetencies, Knowledge and Skills:
nnnIntermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
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nnAbility to communicate effectively with a diverse group of individuals
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nnAbility to multi-task and work independently within a team environment
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nnKnowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
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nnAdhere to code of ethics that aligns with professional practice
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nnKnowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
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nnStrong advocate for members at all levels of care
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nnStrong understanding and sensitivity of all cultures and demographic diversity
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nnAbility to interpret and implement current research findings
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nnAwareness of community & state support resources
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nnCritical listening and thinking skills
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nnDecision making and problem-solving skills
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nnStrong organizational and time management skills
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nnBilingual speaking and writing skills are preferred
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n nLicensure and Certification:
nnnCurrent, unrestricted Registered Nurse licensure in the state of New York required
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nnCase Management Certification preferred
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nnMust have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
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nnTo help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
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nnCareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
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n nWorking Conditions:
nnnThis is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
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nnOver 50% (Mobile) Routine travel required
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n nCompensation Range:
n$100,000 - $135,000
nCareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
nCompensation Type (hourly/salary):
nSalary
nOrganization Level Competencies
nnnFostering a Collaborative Workplace Culture
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nnCultivate Partnerships
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nnDevelop Self and Others
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nnDrive Execution
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nnInfluence Others
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nnPursue Personal Excellence
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nnUnderstand the Business
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n nThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
n#LI-JS2
nBrand=ElderServe
Worksite address
bronx, NY, 10400, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.