High Rise Nurse Care Manager

High Risk Nurse Care Manager

Professional AC 14 Penn, New York, NY, US

9 days ago Requisition

Salary Range: $94,993.00 To $ Annually

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse people who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit http://www.amidacareny.org for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative, and experienced individual to join our team as the High-Risk Nurse Care Manager. Compensation will be commensurate with experience.

Position Summary:

This position serves as an integral part of the member's assigned Integrated Care Team (ICT) and is responsible for intensive care management of high-risk members, care management of services related to the delivery of medical benefits that ensure members' complex medical, behavioral, pharmaceutical and psychosocial needs are met within the established benefit policies and guidelines for the treatment and evaluation of members of a specialized needs plan.

The High-Risk Nurse Care Manager must have strong critical thinking skills to provide clinical oversight to the team and to clinical case reviews.

Responsibilities:

• Provide a single point of coordination/accountability in managing the care of members designated as high-risk.
• Provide comprehensive needs assessment, develop person centered care plan and coordinate appropriate services to meet the members' treatment, support and psychosocial needs. Provide services to members as needed to meet Care Plan objectives, including facilitating referrals to medical, behavioral health and social assistance entities and other services to support wellness and health care compliance.
• Collaborate with the members' treatment providers and community agencies in assessment, planning, and implementing the member's care plan. Coordinate member access to other services such as home health care, Medical Home, durable medical equipment, hospice care, pharmaceutical, vision, and transportation.
• Promptly review and address any crisis situations that arise for any client with supervisory staff, service network and any other required entities. Review and assist in the resolution of member grievances within required regulatory time frames.
• Participate in regularly scheduled ICT Meetings. Ensure Amida Care's Integrated Care Model of Care is operationalized within the team structure and that members' complex, multi-disciplinary service needs are met.
• Coordinate access to behavioral healthcare including review of all HCBS (Home and Community-Based Service) plans of care and complete necessary written clinical documentation for response to providers, oversee and logging all transactions.
• Perform daily review of inpatient census to ensure members are receiving care and services in accordance with established clinical guidelines and in the most appropriate care setting. Follow up with members and providers when a need is identified that will support improved health outcomes for behavioral and physical health.
• Communicate with members of the healthcare team to ensure members are receiving services and care in accordance with established clinical guidelines and the Plan's benefit package;…