Case Manager

Overview

• Provide telephonic assessments of members’ medical, psychosocial, physical, and spiritual needs to ensure comprehensive care planning.
• 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 member needs effectively.
• Educate members on disease processes, preventive health measures, and quality-of-life interventions.
• Conduct initial and scheduled telephonic assessments, reviewing data to develop and update service plans.
• Respond to changes in member conditions by revising service plans and communicating updates to the care team.
• Participate in interdisciplinary care team meetings to discuss member conditions and care strategies.

Key Responsibilities & Duties

• Complete telephonic assessments and review visit data as assigned by the supervisor.
• Develop person-centered service plans based on completed assessments and departmental workflows.
• Revise and update service plans in response to changes in member conditions or sentinel events.
• Collaborate with interdisciplinary teams to ensure effective care delivery and member satisfaction.
• Educate members about healthcare processes, preventive measures, and quality-of-life improvements.
• Adhere to CMS and DOH regulations in care management practices.
• Present cases and updates at interdisciplinary care team meetings.
• Utilize Medicare and Medicaid knowledge to optimize member care plans.

Job Requirements

• Graduate of an accredited nursing program; Bachelor’s degree (BSN) preferred.
• Current RN New York State license; CCM certification preferred.
• Minimum three to five years of nursing experience in long-term care, managed care, home care, geriatrics, or hospice.
• Prior experience in interdisciplinary service delivery environments preferred.
• Working knowledge of Medicare and Medicaid regulations essential.
• Proficiency in developing and implementing person-centered service plans.
• Bilingual proficiency in Mandarin or Cantonese highly desirable.
• Ability to work remotely with occasional hybrid training schedules.