Bay Aging is seeking a full-time, RN Care Manager who is a Registered Nurse to be responsible for the overall management of a sub-population of DMAS-identified Mandatory High Priority members who must receive High Intensity care management and perform pre-service clinical reviews of Home amp; Community Based Services (HCBS).nbsp; Candidates must have at least 2 years experience in the medical field or long term care environment;nbsp; a year of experience as an RN in pediatric home health case-management for care coordination preferred.nbsp;nbsp;nbsp;nbsp; Experience with PDN authorizations preferred.nbsp;nbsp;nbsp; Experience with LTSS authorizations preferred. Come share your talent with us.nbsp; Reports to Director, Health Services. Salary:nbsp; $85,000/year-$95,000/yr

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ESSENTIAL FUNCTIONS

1.nbsp;nbsp;nbsp;nbsp; Responsible for meeting DMAS contractual requirements related to Initial HRA, MMHS Screening, ICPs, ICT, and minimum mandatory contacts.

2.nbsp;nbsp;nbsp;nbsp; Conducting face-to-face visits.nbsp;

3.nbsp;nbsp;nbsp;nbsp; Responsible for oversight of PDN authorizations, including Utilization Management (UM) aspects of the authorization process.

4.nbsp;nbsp;nbsp;nbsp; Responsible for oversight of HCBS UM authorizations.

5.nbsp;nbsp;nbsp;nbsp; Provide primary case management across the continuum for these medically fragile and complex members to include following members through inpatient hospitalizations, assisting with transitions of care, and coordinating HCBS service needs.

6.nbsp;nbsp;nbsp;nbsp; Serve as lead contributor to the oversight of and accountability for member-specific quality measures (HEDIS, NCQA) (will have support and assistance from Quality Department)

7.nbsp;nbsp;nbsp;nbsp; Collaborates with community resources, health care providers and family caregivers to coordinate necessary member service.

8.nbsp;nbsp;nbsp;nbsp; Provides frequent telephone contact with members and service providers to assess situations and assure that services are in place and appropriate.

9.nbsp;nbsp;nbsp;nbsp; Participates in regular meetings and conference calls.

10.nbsp; Enters data into Managed Care Organization (MCO) web-based data software system.

11.nbsp; Completes accurate and timely documentation on each member.

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KNOWLEDGE, SKILLS AND ABILITIES

Rely on on-the-job training and experience to accomplish the work. Working knowledge of:

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Microsoft Office programs (e.g. Word, Excel, Outlook, PowerPoint) and standard office equipment

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Data entry and evaluation

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Strong customer service and interpersonal skills to establish and maintain trusting professional relationships.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Excellent verbal communication skills face-to-face and telephonically

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Excellent written communication skills (letters, memos, reports, emails)

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Understanding of client confidentiality and HIPPA privacy rules

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Recording client data and accurately entering information into computer systems in a timely manner

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Previous experience working in an office setting and using computerized multi-line call systems

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WORKING ENVIRONMENT

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; This position is a remote (work from home) position; however, home visits to assigned members are required on a recurring basis.nbsp;

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Home based internet service preferred.nbsp; Must have reliable transportation and a valid driver’s license.nbsp;

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Corporate office located in Urbanna, Virginia.nbsp; On-site work may also be required for training, etc.nbsp;

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MINIMUM QUALIFICATIONS

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Must be licensed by the Virginia Board of Nursing or hold a current multi-state licensure privilege to practice nursing in Virginia as a Registered Nurse. Have at least 2 years of experience in the medical field or long-term care environment.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Excellent problem-solving ability, organizational skills, and capacity to work independently or as a team.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Demonstrated competence in applying processes designed to ensure adherence to all pertinent federal and state rules and regulations.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Strong work ethic and attention to detail

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Sensitivity to the special needs of children who rely on technology and their families, to include understanding the stress and challenges they may experience.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Understanding of the importance of bringing quality considerations into every touch point

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Strong prior performance in meeting requirements for HRA completion, managing members with complex health care needs, and ability to manage complex workload.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; 1 year of experience as an RN in pediatric home health case-management for care coordination preferred.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Experience with PDN authorizations preferred.

• nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Experience with LTSS authorizations preferred.

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FLSA status: This is an exempt position.

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nbsp;Disclaimer: This job description is not designed to cover or contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. From time to time, the supervisor will ask job holder to perform additional duties related to the completion of the work.

nbsp;Bay Aging is an Equal Opportunity Employer.nbsp;All applicantsnbsp;willnbsp;be considered fornbsp;employmentnbsp;without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran or disability status.nbsp; Bay Aging is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact MaDena DuChemin, Human Resource Manager at (804) 758-2396, Ext. 1228 or mduchemin@bayaging.org.

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