Case Manager

Overview

• Provide care coordination for elderly and disabled members, ensuring optimal health outcomes and independence.
• Conduct in-home assessments to evaluate members' health, living conditions, and care needs.
• Collaborate with interdisciplinary teams to develop and implement personalized care plans.
• Monitor members' health status and eligibility for services, ensuring compliance with plan criteria.
• Coordinate care across various settings, including hospitals, long-term care facilities, and home environments.
• Advocate for members' needs while maintaining cost-effective care solutions.
• Document care management activities in alignment with organizational policies and standards.
• Support members in achieving the highest level of independence possible.

Key Responsibilities & Duties

• Perform home visits to assess members' cultural, functional, and cognitive needs.
• Collaborate with physicians and interdisciplinary teams to create patient-centered service plans.
• Authorize covered services and ensure appropriate levels of care are provided.
• Investigate and document grievances, ensuring timely resolution.
• Evaluate care management reviews and formulate appropriate plans of care.
• Ensure safe discharge plans for members transitioning from care facilities.
• Maintain accurate documentation of care coordination activities and member interactions.
• Participate in intensive care management meetings for complex cases.

Job Requirements

• Bachelor of Science in Nursing (BSN) required; Associate degree in Nursing acceptable.
• Minimum of 2 years of experience as a registered nurse; 4 years preferred.
• Clinical experience in geriatrics or managed long-term care is highly desirable.
• Proficiency in Microsoft Office applications, including Outlook, Word, and Excel.
• Current, unrestricted Registered Nurse licensure in New York State required.
• Case Management Certification preferred.
• Bilingual proficiency in Spanish or Chinese is preferred.
• Strong organizational, decision-making, and problem-solving skills.