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, primary care providers, members, and specialists to address healthcare needs.
• Utilize benefit structures and community-based resources to meet members' needs effectively.
• Educate members on disease processes, preventive health, and quality of life interventions.
• Adhere to CMS/DOH guidelines and complete initial telephonic assessments and UAS-NY visit data reviews.
• Revise and update person-centered service plans based on reassessments and changes in members' conditions.
• Participate in interdisciplinary care team meetings to discuss member conditions and care strategies.

Key Responsibilities & Duties

• Conduct comprehensive telephonic and in-home assessments of members' healthcare needs.
• Develop and implement personalized care plans addressing medical, psychosocial, and physical requirements.
• Monitor and revise care plans based on reassessments and sentinel events.
• Collaborate with interdisciplinary teams to ensure effective care coordination and communication.
• Educate members on health management and disease prevention strategies.
• Utilize Medicare and Medicaid regulations to optimize care delivery.
• Participate in care team meetings to present cases and discuss member conditions.
• Adhere to departmental workflows and guidelines for assessments and service plan development.

Job Requirements

• Associate of Science (AS) degree; Bachelor of Science in Nursing (BSN) preferred.
• Current RN New York State license; CCM certification preferred.
• Three to five years of nursing experience in long-term care, managed care, home care, geriatrics, or hospice.
• Knowledge of Medicare and Medicaid regulations and interdisciplinary service delivery environments.
• Strong communication and collaboration skills for effective team engagement.
• Ability to conduct assessments and develop personalized care plans.
• Proficiency in utilizing community-based resources and benefit structures.
• Bilingual proficiency in Mandarin or Cantonese preferred.