Case Manager MLTC

Duties:

• Provide telephonic and as needed in-home assessments of members’ medical, psychosocial, physical and spiritual needs.
• Develops, implements, and monitors person centered service plan, and ensures continuity of care across all healthcare settings by collaborating with the interdisciplinary care team, PCP, member/member’s representatives, and specialists.
• Utilizes benefit structure and community-based resources to meet member’s needs.
• Educates members on disease processes, preventative health, and quality of life interventions.
• RN Care Manager will be knowledgeable in and adhere to CMS/DOH 
• Completes initial telephonic assessments and reviews UAS -NY visit data as assigned by the Supervisor of Coordinated Care in accordance with departmental workflow.
• Utilizes completed assessments to develop a Person-Centered Service Plan (PCSP) 
• Completes scheduled telephonic re-assessments and reviews UAS -NY visit data based on the plan specific reports as per departmental workflow. Utilizes completed re-assessments to revise/update a Person Centered Service Plan (PCSP).
• Responds to changes in member’s condition/sentinel events (i.e. level of care changes, changes in family support, changes in housing, etc.) by revising the PCSP and communicating changes to interdisciplinary team
• Participates in and presents cases at the Interdisciplinary Care Team meetings to discuss any changes in member’s condition/sentinel events Education Graduate of an accredited nursing program,

Qualifications:

• RN – Bachelor’s degree (BSN) preferred.
• Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice Prior experience in an interdisciplinary service delivery environment preferred.
• Working knowledge of Medicare and Medicaid regulations Prior experience in an interdisciplinary service delivery environment preferred.
• Current RN New York State license; CCM preferred