Case Manager

Overview

• Provide care coordination for elderly and disabled members, ensuring quality and cost-effective health outcomes.
• Conduct in-home assessments to evaluate members' health needs and living conditions.
• Collaborate with interdisciplinary teams to develop and implement personalized care plans.
• Advocate for members to maintain independence and access appropriate services.
• Monitor members' eligibility for services and adjust care plans accordingly.
• Ensure compliance with healthcare laws, regulations, and company policies.
• Document care management activities and member interactions accurately.
• Perform home visits to assess functional and cognitive needs, ensuring safe discharge plans.

Key Responsibilities & Duties

• Coordinate care across various settings including hospitals, long-term care, and home environments.
• Authorize covered services and ensure utilization of network providers.
• Collaborate with primary care physicians and interdisciplinary teams to develop service plans.
• Respond to member requests promptly and address grievances as per policy.
• Identify complex care management cases for intensive review and planning.
• Document care coordination activities and maintain compliance with standards.
• Perform telephonic and in-person recertifications as required by member plans.
• Develop efficient care plans tailored to members' needs and preferences.

Job Requirements

• Bachelor of Science in Nursing (BSN) required; Associate degree acceptable with relevant experience.
• Minimum of 2 years of experience as a Registered Nurse; 4 years preferred.
• Clinical experience in geriatrics or managed long-term care highly desirable.
• Current, unrestricted Registered Nurse licensure in New York State required.
• Case Management Certification preferred; knowledge of CMSA standards essential.
• Proficiency in Microsoft Office applications and ability to work in a hybrid environment.
• Strong organizational, decision-making, and problem-solving skills required.
• Bilingual communication skills preferred to meet diverse member needs.