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Job description
RN Care Manager - Full Time - Days
nDepartment: CARE MGMT SVCS
nJob Summary
nThe Care Manager is responsible for completing a comprehensive assessment to determine the correct services and benefits based on medical necessity for an enrollee. Provides plan education, transition of enrollees to clinical services based on Department of Health (DOH) guidelines. Care management providing advocacy, coordination and oversight of all healthcare services for an enrollee striving to deliver the best care at the right time and in the most-cost effective while meeting quality outcome standards for the enrollee case load assigned. Complies with all state and federal regulations including Health Insurance Portability and Accountability Act (HIPAA).
nCore Job Responsibilities
nnnIdentifies and coordinates enrollee services as provided by the plan and services that are not a benefit of the plan (Medicare Services).
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nnCompletes comprehensive assessment using the DOH approved tool to determine eligibility of medically necessary services.
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nnEducates and completes with enrollee all necessary consents and documentation.
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nnInitiates and carries out continuous assessment of physical, emotional, social, cultural, economic, and environmental needs of the enrollee and coordinates services for needs as determined.
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nnObserves the enrollee for changes in condition and follows up with appropriate services or providers to attempt to prevent disease exacerbations.
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nnDevelops, monitors and revises a Plan of Care with the enrollee or enrollee’s designee that has problem, enrollee centered goals and interventions.
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nnImplements orders for Durable Medical Equipment items and treatments as prescribed by the physician, submitting and maintaining appropriate medical orders and documentation.
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nnCompletes documentation per company standards/policy utilizing an Electronic Medical Record (EMR) system.
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nnParticipates in Marketing Activities as requested by Executive Director or Designee.
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nnAccepts assignments and performs duties within their nursing scope of practice, seeking and obtaining sufficient information/education necessary to function effectively in the managed long term care setting.
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nnParticipates in departmental and organizational committees and meetings as applicable.
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nnParticipates in the orientation of new staff, mentors peers, and promotes collaborative teamwork.
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nnPerforms all duties and responsibilities in accordance with the Nurse Practice Act and in accordance with the basic principles of professional nursing.
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nnMaintains a working knowledge of, and adheres to applicable federal/state regulations including, but not limited to, patient confidentiality, release of information, and HIPAA.
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nnPerforms other related duties as requested by the Executive Director or Clinical Services Manager.
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nnClarifies issues and actively addresses concerns in a timely manner.
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nnAbility to manage conflict, stress, and multiple simultaneous work demands in an effective, professional manner.
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nnAbility and willingness to self-motivate, prioritize, and be willing to change processes to improve effectiveness efficiency. Adapts to changing enrollee or organizational priorities.
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nnAbility to make independent decisions in accordance with established policies and procedures.
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nnPerforms related duties as assigned.
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n nEducation/Experience Requirements
nREQUIRED:
nnnComputer literacy, including but not limited to data entry, retrieval, and report generation.
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nnExcellent written, verbal and listening communication skills.
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nnStrong organizational and time management skills.
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nnAbility to work with patients/families of all ages and in a variety of settings, including inpatient facility and patients’ homes presenting diverse physical conditions and social/cultural environments.
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nnAbility to drive to and from a variety of settings in varying weather conditions.
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n nPREFERRED:
nn1-2 years in community based care or health care area that cares for the community population.
n nLicensure/Certification Requirements
nREQUIRED:
nnnLicensed and currently registered to practice as a Registered Professional Nurse or BSN in New York State, with preferred 1-2 years in community based care or health care area that cares for the community population.
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nnValid New York State driver’s license and personal vehicle.
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nnCurrent Basic Life Support (BLS) Certification.
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n nDisclaimer
nQualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
nSuccessful candidates might be required to undergo a background verification with an external vendor.
nJob Details
nReq Id 96573
nDepartment CARE MGMT SVCS
nShift Days
nShift Hours Worked 8.50
nFTE 1
nWork Schedule SALARIED GENERAL
nEmployee Status A1 - Full-Time
nUnion Non-Union
nPay Range $66,000 - $100,000 Annually
Worksite address
utica, NY, 13502, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.