Case Manager

Overview

• Provide comprehensive telephonic and in-home assessments of members' medical, psychosocial, and physical needs to ensure optimal care delivery.
• Develop and implement personalized care plans addressing diverse healthcare requirements and ensuring continuity across care settings.
• Collaborate with interdisciplinary teams, primary care providers, and specialists to coordinate effective care strategies.
• Educate members on health management, disease prevention, and quality of life improvement practices.
• Utilize community resources and benefit structures to meet members' unique needs effectively.
• Adhere to regulatory guidelines and complete assessments and data reviews as required.
• Revise care plans based on reassessments and changes in members' conditions to ensure optimal outcomes.
• Participate in interdisciplinary team meetings to discuss member conditions and care strategies.

Key Responsibilities & Duties

• Conduct thorough telephonic and in-home assessments to evaluate members' healthcare needs and conditions.
• Develop and monitor individualized care plans ensuring alignment with members' health goals and requirements.
• Collaborate with interdisciplinary teams to ensure seamless care coordination and communication across stakeholders.
• Educate members on preventive health measures and disease management strategies to promote well-being.
• Utilize Medicare and Medicaid regulations to optimize care delivery and resource utilization.
• Participate in care team meetings to present member cases and discuss strategies for improved outcomes.
• Adhere to established workflows and guidelines for assessments and care plan development.
• Revise care plans based on sentinel events and reassessments to ensure continuity and effectiveness.

Job Requirements

• Associate of Science (AS) degree required; Bachelor of Science in Nursing (BSN) preferred.
• Active RN license in New York State; CCM certification is a plus.
• Three to five years of nursing experience in long-term care, managed care, home care, geriatrics, or hospice settings.
• Proficiency in Medicare and Medicaid regulations and interdisciplinary care environments.
• Strong communication and collaboration skills to engage effectively with teams and members.
• Ability to conduct assessments and develop personalized care plans tailored to individual needs.
• Knowledge of community-based resources and benefit structures to support member care.
• Bilingual proficiency in Mandarin or Cantonese is preferred but not required.