Case Manager

Overview

• Provide telephonic and in-home assessments of members’ medical, psychosocial, physical, and spiritual needs.
• Develop, implement, and monitor person-centered service plans ensuring continuity of care across healthcare settings.
• Collaborate with interdisciplinary care teams, PCPs, members, representatives, and specialists to address healthcare needs.
• Utilize benefit structures and community-based resources to meet member needs effectively.
• Educate members on disease processes, preventative health, and quality of life interventions.
• Complete initial telephonic assessments and review UAS-NY visit data as assigned.
• Respond to changes in members’ conditions and revise service plans accordingly.
• Participate in interdisciplinary care team meetings to discuss member conditions and events.

Key Responsibilities & Duties

• Conduct telephonic and in-home assessments to evaluate member needs and conditions.
• Develop and update person-centered service plans based on assessment findings.
• Collaborate with interdisciplinary teams to ensure comprehensive care delivery.
• Educate members on health management and preventive care strategies.
• Monitor member progress and adapt care plans to address changing needs.
• Utilize Medicare and Medicaid regulations to guide care management practices.
• Participate in team meetings to discuss cases and coordinate care strategies.
• Ensure compliance with CMS/DOH guidelines and departmental workflows.

Job Requirements

• Graduate of an accredited nursing program; Bachelor’s degree (BSN) preferred.
• Current RN license in New York State; CCM certification preferred.
• Three to five years of nursing experience in long-term care, managed care, or geriatrics.
• Knowledge of Medicare and Medicaid regulations and interdisciplinary care delivery.
• Ability to conduct assessments and develop person-centered service plans.
• Proficiency in telephonic and in-home care management practices.
• Bilingual proficiency in Mandarin/Cantonese is highly desirable.
• Strong communication and collaboration skills with interdisciplinary teams.