Case Manager

Overview

• Provide comprehensive care coordination for elderly members, ensuring optimal health outcomes and independence.
• Conduct in-home assessments to evaluate members’ needs, living situations, and cultural influences.
• Collaborate with interdisciplinary teams to develop personalized care plans for members.
• Monitor members’ eligibility for services and adjust plans accordingly.
• Facilitate communication between members, families, and healthcare providers.
• Ensure adherence to healthcare regulations and organizational policies.
• Promote quality, cost-effective care solutions tailored to individual needs.
• Support members in maintaining independence and navigating healthcare systems.

Key Responsibilities & Duties

• Perform regular home visits to assess members’ functional and cognitive needs.
• Coordinate care across various settings, including hospitals and long-term care facilities.
• Develop and implement efficient care plans using network providers.
• Document care management activities according to organizational policies.
• Address grievances and ensure timely resolution as per policy guidelines.
• Advocate for members’ needs at all levels of care.
• Participate in intensive care management meetings for complex cases.
• Ensure safe discharge planning for members transitioning between care settings.

Job Requirements

• Bachelor of Science in Nursing (BSN) required; Associate degree accepted with relevant experience.
• Minimum of 2 years of nursing experience; 4 years preferred.
• Registered Nurse licensure in New York State required.
• Case Management Certification preferred.
• Proficiency in Microsoft Office applications and electronic health records.
• Bilingual Spanish or Chinese speaking and writing skills preferred.
• Strong organizational, decision-making, and problem-solving skills.
• Knowledge of healthcare laws, regulations, and case management standards.