Nurse Care Manager (Medicare)

Job Overview:

The Medicare Care Manager is primarily responsible for providing telephone-based services, including outreach, education, counseling, self-management support, and care integration for members. Responsibilities include routine communication with member, coordination of benefits, identification of resources and informal supports, hospital discharge planning as well as engagement in transition of care program.

Essential Responsibilities:

• Facilitates communication between patient, health care provider, and community.
• Communicates with member, member’s family, and health professionals in coordinating care for member.
• Implements performance improvement strategies as identified through review of patient and program outcomes.
• Post-hospitalization follows member based on protocols in Transition of Care Program.
• Ensures all activities are patient-focused and individualized, resulting in personalized attention to each individual’s unique needs.
• Identifies interventions and resources to assist member in reaching personal health- related goals.
• Identifies patterns and improvement strategies to help members improve their health and achieve optimal care goals.
• Potential to work directly with Residences, Adult Homes, etc., and monthly visits to residences with whom they work.
• Timely and thorough documentation in members’ charts.
• Other duties as identified as a necessary part of employee’s role.

Specific Knowledge, Skills, and Abilities:

• Valid New York State, unrestricted, RN license.
• Bachelor’s Degree (BSN) preferred.
• Excellent communication, written and analytical skills.
• Computer savvy.

Schedule:

• Hybrid schedule (3 days in office & 2 days remote).