Case Manager

Overview

• Provide comprehensive care management services to members, ensuring their medical, psychosocial, physical, and spiritual needs are met effectively.
• Develop, implement, and monitor person-centered service plans to ensure continuity of care across healthcare settings.
• Collaborate with interdisciplinary teams, primary care providers, and specialists to deliver optimal care solutions.
• Conduct telephonic and in-home assessments to evaluate members' conditions and needs.
• Educate members on disease management, preventive health measures, and quality of life improvements.
• Adhere to CMS and DOH regulations, ensuring compliance with healthcare standards.
• Utilize benefit structures and community resources to address members' needs effectively.
• Participate in interdisciplinary care team meetings to discuss and address changes in members' conditions.

Key Responsibilities & Duties

• Complete initial and scheduled telephonic assessments, reviewing UAS-NY visit data as per departmental workflow.
• Develop and revise person-centered service plans based on assessment findings and changes in members' conditions.
• Respond to sentinel events and condition changes by updating service plans and communicating with the care team.
• Educate members on disease processes, preventive health, and quality of life interventions.
• Collaborate with interdisciplinary teams to ensure coordinated and effective care delivery.
• Utilize community-based resources and benefit structures to meet members' needs.
• Participate in care team meetings, presenting cases and discussing care strategies.
• Ensure compliance with Medicare and Medicaid regulations in care delivery processes.

Job Requirements

• Graduate of an accredited nursing program; 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, home care, geriatrics, or hospice.
• Experience in interdisciplinary service delivery environments is advantageous.
• Knowledge of Medicare and Medicaid regulations is essential.
• Strong communication and collaboration skills to work effectively with interdisciplinary teams.
• Ability to conduct telephonic and in-home assessments and develop service plans.
• Proficiency in utilizing community resources and benefit structures to address members' needs.