Inpatient Case Manager RN

Overview

The challenges of affordable healthcare continue to create new opportunities. Elderplan and Home First, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients’ and members’ needs. These high‑quality healthcare plans are designed to help keep people independent and living life on their own terms.

Provide quality cost‑effective care to all members by evaluating the need for and pre‑authorizing requests for inpatient, outpatient, specialty care, home care, DME, and transportation services, from network and out‑of‑network providers, in accordance with departmental criteria and guidelines.

• Graduate of an accredited nursing program;
  Bachelor’s degree preferred.
• Minimum of three (3) years experience in medical/surgical nursing.
• Working knowledge of utilization management processes.
• Knowledge of Federal and State managed care regulations.
• Prior managed care experience preferred.
• Working knowledge of Windows, Word, Excel.
• Licensed to practice as a registered nurse in the state of New York with current registration.
• CCM preferred.
• Knowledge of current standards of medical practice.
• Ability to solve problems through the application of nursing theory and processes.
• Excellent written and oral communication skills.
• Knowledge of current standards of the healthcare delivery system.
• Ability to set priorities.
• Ability to work independently while recognizing issues having departmental or organizational impact.
• Ability to work as a team member and facilitate communication among the member, healthcare providers, community and medical management staff.

Elderplan in order to meet the healthcare needs of the member.