Care Solutions' goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
JOB SUMMARY:
The Care Manager works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. Through interventions such as complex case management and utilization management, the care manager will ensure coordination of health care services, member education, and preventative interventions.
PRIMARY RESPONSIBILITIES:

• Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
• Develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the member’s care.
• Initiates utilization review for preauthorization and post service reviews
• Utilizes knowledge of community resources and the member’s benefit structure
• Interacts with providers and facilities in a professional, respectful manner
• Recognizes quality of care issues and escalates the issues appropriately
• Assists members with the coordination of services from various settings as appropriate
• Complies with all CCSs standards for documentation
• Participates in case rounds
• Participates in on call coverage
• Participates in other meetings as requested
• Participates in quality improvement initiatives
• Other duties as assigned

Required:

• Active and unrestricted NYS RN license
• Minimum 2 years case management experience with the geriatric population
• Strong written and verbal communication skills

Preferred:

• Graduate of a 2 to 4-year accredited nursing program
• Active and unrestricted NYS RN license
• CCM certification
• Knowledge of Milliman or InterQual criteria
• Experience providing care in the home setting
• Experience providing care in the home setting
• Experience providing care in the home setting

We offer:

• Hybrid schedule (for employees who qualify)

The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required. The job description doesn’t constitute an employment agreement between the employer and employee, and is subject to change by employer.
Care Solutions is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.