Registered Nurse

Responsibilities:

• Lead a team of Nurse Care Managers for the managed services organization, directing various care management programs. These programs encompass but are not limited to Chronic Disease Program, Complex Case Management, Special needs Population, Coordination of Care and Transition of Care Programs
• Audit and monitor CM team members’ work to ensure accuracy, timely processing, develop and implement training/retraining programs to address any gaps or new requirements
• Responsible for departmental compliance with performance standards of various regulatory bodies including contracted Health Plans, Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), state, federal and Department of Labor
• Work with leadership team to develop, update and implement CM policies, procedures and guidelines
• Assist with CM audits, including document preparation and participation in on-site or remote audits, as a subject matter expert
• Oversee CM team providing guidance and training as needed

Requirements:

• Bachelor of Science Degree in Nursing (BSN)
• Active unrestricted NYS RN License required
• Minimum of five (5) years’ clinical experience preferred
• Minimum of three (3) years supervisory experience preferred
• CM experience in a Managed Care setting preferred
• UM experience in a managed care setting preferred