Responsibilities Include:

• Develops and updates the individualized care plan based on a comprehensive assessment of members in consultation with the member and family/caregiver and the assessment nurse
• Implements the care plan and authorizes/arranges for delivery of covered services consistent with the care plan
• Conducts ongoing communication and collaboration with a member, family caregiver, or member's designated representative, as well as with member's PCP and other significant health care providers
• Monitors provision of services by network providers to ensure they are appropriate and in accordance with the member's care plan
• Conducts ongoing monitoring of member's health, safety, and functional status, and progress toward established goals
• Provides coordination of care transitions, including discharge and transition planning from the hospital or nursing homes
• Determines member eligibility for the company's program and quality initiatives; Facilitates the establishment of Advance Care Planning and assures appropriate administration of the member's Health Care Proxy
• Reviews member's medical status and issues, identifying follow-up issues
• Serves as primary contact with member's PCP or specialist physicians as well as member's long-term care service providers
• Monitors member's medication adherence in conjunction with the RN, Care Management Supervisor
• Provides education/coaching in self-management of disease processes
• Conducts monthly outreach to the member to check on member's status
• Updates member case records
• Participate in Quality Assurance and Improvement activities as directed by the Director of Care Management
• Other duties as assigned by the Care Management Supervisor and/or the Director of Care Management

Qualifications:

• Bachelor’s or Associates Degree in Nursing
• NEW YORK STATE NURSING LICENSE and located within the tri-state area
• Minimum of one-year experience in clinical practice, case management, care management, or home care
• Experience in managed care and/or care management preferred
• Experience with geriatric population preferred

#INDHCDH

Job Type: Full-time

Pay: $90,000.00 - $105,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Office
• Remote

Application Question(s):

• Do you live in the New York Metropolitan Area?

Experience:

• Nursing: 2 years (Preferred)
• Case management: 1 year (Preferred)

License/Certification:

• NEW YORK STATE NURSING LICENSE (Required)

Work Location: Remote