Job Title: Care Manager - RN

Location: Bronx, NY (hybrid, 1-2 days a week in the office)

Position Type: Full-time, Direct Hire

Hours: Day shift, M-F

Pay: 95,000-115,000 DOE

The Case Manager, RN works closely with the clinical quality team, clinical quality data and analytics team, networking, and leadership to ensure that all enrolled patients receive appropriate, high quality health care.

Responsibilities

• Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors.
• Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members health across the care continuum.
• Assess the member's health, psychosocial needs, cultural preferences, and support systems.
• Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes.
• Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services).
• Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family.
• Advocate for members and promote self-advocacy.
• Deliver education to include health literacy, self-management skills, medication plans, and nutrition.
• Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary.
• Accurately document interactions that support management of the member.
• Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.
• Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.
• Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
• Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals
• Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).

COMPETENCIES AND QUALIFICATIONS

• Bachelor's Degree.
• 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required.
• 1 year of case management experience in a managed care setting.
• Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.
• Current, active, and unrestricted New York Registered Nurse license required
• Certification in Case Management (CCM) required or to be obtained within 18 months of hire
• Certification in Chronic Care Professional (CCP) preferred
• Ability to think critically, be decisive, and problem solve a variety of topics that can impact a members outcomes.
• Empathetic, supportive and a good listener.
• Proficient in motivational interviewing skills.
• Demonstrated time management skills.
• Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member.
• Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).
• Must embrace teamwork but can also work independently.
• Strong communication (oral, written, presentation), relationship building, planning, and implementation skills.
• Demonstrated ability to handle projects independently, effectively, and efficiently.
• Willingness to travel periodically to meet with patients in the inpatient setting during discharge planning process or in the home.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.