Hybrid Registered Nurse; RN Care Manager - Bronx​/Westchester

Position: Hybrid Registered Nurse (RN) Care Manager - Bronx/Westchester
Location: New York

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* Job Summary:

** The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.

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* Essential Functions:

*** Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status.
* Authorizes covered services and coordinates care regardless of payer.
* Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
* Works with member/family to maintain the most independent living situation possible
* Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
* Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria.
* Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs.
* Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
* Ensures appropriate, safe plan for members’ discharge from their plan.
* Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.
* Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
* Responds to members’ requests in the designated time frames and completes Initial Adverse Determinations (IAD) as indicated
* Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.
* Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.
* Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members’ needs.
* Perform any other job related duties as requested.  
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* Education and Experience:

*** Associates degree in Nursing from an accredited nursing program required
* Bachelor's degree in Nursing preferred
* Three (3) years of experience as a registered nurse required
* Clinical experience in geriatrics and/or managed long-term care experience preferred
* Experience using multiple languages may be required based on operational needs
** Competencies, Knowledge and

Skills:

*** Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
* Ability to communicate effectively with a diverse group of individuals
* Ability to multi-task and work independently within a team environment
* Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
* Adhere to code of ethics that aligns with professional practice
* Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
* Strong advocate for members at all levels of care
* Strong understanding and sensitivity of all cultures and demographic diversity
* Ability to interpret and implement current research findings
* Awareness of community & state support resources
* Critical listening and thinking skills
* Decision making and problem-solving skills
* Strong organizational and time management skills
* Bilingual speaking and writing skills are preferred
** Licensure and Certification:
*** Current, unrestricted Registered Nurse licensure in the state of New York required
* Case Management Certification preferred
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* Working Conditions:

*** General office environment; may be required to sit or stand for extended periods of time
* Up to 25% (regular) travel may be required to travel to different locations, including homes, offices, or other public settings, to perform work duties
** Compensation Range:**$100,000…