Job Ref: 45252
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT PROGRAM
Location: New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $93,866.00
Salary Range: $93,866.00 - $93,866.00
- Physically meet the members where they are to gain deep understanding of their situation and needs
- Problem solve member’s problems and needs: clinical, psychosocial, financial, environmental
- Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation
- Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well being
- Assess risks and gaps in care
- Maximize member’s access to available resources
- Prepare member oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
- Communicate plan of care to Primary Care Physician initially and no less than monthly with updates
Insure member caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers using verbal and nonverbal techniques
- Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
- Provide complex care management including but not limited to; insuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
- Advocate for members by assisting them to address challenges, and make informed choices regarding clinical status and treatment options
- Ability to use data as a tool in tracking and trending outcomes and clinical information
- Maintain accurate, comprehensive and current clinical and non-clinical documents
- Clinical background: RN
- Bachelor’s Degree required
- Minimum of 2 years medical surgical experience required
- Field experience providing care management or care coordination required
- Prior experience in Case Management in a health care and/or Managed Care setting strongly preferred
- Proficiency with computers navigating in multiple systems and web based applications
- Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
- Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
- Time management and organizational skills
- Strong problem solving skills
- Ability to prioritize and manage changing priorities under pressure
- Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
- Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
- Ability to travel within the MetroPlus service area making home visits to members, facility visits to clinical providers, and visits to community, faith and other social service based agencies.
- Registered Nurse with current New York State license
- Foreign medical school graduates considered
The Care Manager, working under the direction of the Director of the Department of Utilization Management, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of both outpatient and inpatient services. The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.
Our Vision To be the number one plan of choice for the communities we serve.
organization, from leadership
to frontline staff, to embody
Our Core Values:
- Give care and compassion to all
- Be customer powered: Align daily actions to positive, impactful customer experiences, connect with internal and external customers
- Be proud of what we do: Take ownership and accountability, be solutions driven
- Act as a team: Build trust, empower others, champion transparent communication
- Thrive with change: Spark and support innovation, transform our business through technology and data
"Diverse workforce with some very talented managers and staff. A great place to learn if you are energetic and passionate. A great deal of opportunity for those that work hard and accomplish goals."
Current Employee / Anonymous Employee in New York, NY says:
"Large company with many opportunities. Good knowledgeable people. Friendly and cooperative environment. Relaxed atmosphere. Grate benefits and competitive salaries."
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Equal Opportunity Employer