Elderwood Health Plan is seeking an RN Care Manager - MLTC (Managed Long Term Care) to join our incredible growing team of professionals in Rochester, NY!

Why should you join Elderwood Health Plan?

Monday-Friday Schedule w/ no weekends or overnights
• Medical, Dental & Vision upon 1st of month following 60 days of hire
• Up to 140 hours (19 days) of PTO time PLUS six (6) holidays within the 1st year
• 401(k) retirement plan with vested employer match up to 4%
• Substantial Referral program

In the role of an RN Care Manager, You will partner with the Social Worker and are a critical resource for our members as you are responsible for assessing a member's home health and level of care needs, assisting them in accessing necessary covered services, providing referrals and coordinating other medical services in support of their member centric service plan.

The RN Care Manager also assists our members with obtaining needed medical, social, educational, psychosocial, financial, and other services, irrespective of whether the needed services are covered Elderwood Health Plan.

• Provide a care management process of assessment, planning, facilitation, and advocacy for options and services to meet a member's home health needs
• Perform comprehensive (physical, emotional, psychosocial, and environmental) assessments in the Member's home to assess potential enrollees' appropriateness for Managed Long-Term Care (MLTC), or to reassess a member's status and needs.
• Developing and maintaining of a person-centered service plan based on a needs' assessment
• Review financial, legal, or medical issues and refer Members to social work or other professionals
• Ensure that documentation in the care management record meets all applicable professional standards
• Early identification of incipient problems or significant changes in Member conditions to initiate early intervention
• Competently use the UAS-NY assessment tool. (Preferred)
• Use of standard patient assessment instruments such as PRI, UAS-NY

• Current New York State Registered Nurse License and a valid NYS Driver's license (Required)
• BSN or AAS Degree or diploma in Nursing and Case Management Certification (Preferred)
• Minimum of three (3) years nursing experience in home care, case management, discharge planning or managed care
• Minimum of one (1) year experience working with a frail or elderly population
• Minimum one (1) year experience with health assessments
• Demonstrated favorable interpersonal and assessment skills.
• Ability to identify patterns, connections and underlying themes that lead to understanding and resolving complex problems or situations.
• Familiarity with provisions of governmental and accrediting agency health plan requirements
• Familiar with applying clinical criteria when determining medical necessity and/or benefit administration.
• HIPAA Privacy
• Must possess computer skills, including working knowledge of Electronic Medical Records (EMR), Microsoft Office Suite (365)

This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.