Case Manager

Overview

• Provide remote case management services, addressing members' medical, psychosocial, and spiritual needs effectively and compassionately.
• Develop and implement personalized care plans to ensure optimal healthcare delivery and member satisfaction.
• Collaborate with interdisciplinary teams to enhance care strategies and achieve positive health outcomes.
• Conduct thorough assessments through telephonic and virtual visits to evaluate member conditions and needs.
• Educate members on health management, preventive care, and lifestyle improvements to promote overall well-being.
• Ensure compliance with healthcare regulations and standards in all aspects of service delivery.
• Utilize community resources and benefit structures to address diverse member needs effectively.
• Participate in care team meetings to discuss member conditions and coordinate comprehensive care plans.

Key Responsibilities & Duties

• Perform initial and ongoing assessments using UAS-NY data to inform care planning and decision-making.
• Develop, revise, and monitor personalized service plans tailored to individual member needs and conditions.
• Respond to sentinel events and adapt care plans to address evolving health situations effectively.
• Educate members on disease management, preventive measures, and strategies for improving quality of life.
• Collaborate with healthcare teams to ensure coordinated and effective care delivery across disciplines.
• Leverage available resources to address member needs and enhance overall care outcomes.
• Present cases and care strategies during interdisciplinary team meetings to optimize member care.
• Maintain compliance with Medicare and Medicaid regulations in all aspects of care management.

Job Requirements

• Associate degree in nursing or related field; BSN preferred for advanced care expertise.
• Current RN license in New York State; CCM certification is advantageous for case management roles.
• Three to five years of nursing experience in relevant healthcare settings, demonstrating proficiency in care delivery.
• Experience in interdisciplinary care environments and familiarity with healthcare regulations.
• Proficiency in conducting assessments and developing effective, personalized care plans.
• Strong communication skills for collaboration with diverse healthcare teams and stakeholders.
• Ability to navigate community resources and benefit structures to support member needs.
• Commitment to delivering high-quality, compliant healthcare services with a focus on member-centered care.