Care Manager, RN , Home Care / Hospice / Home Visit - Webster

Job Title: Care Manager - RN
Reports to: Manger of Care Management
Exempt Status:
Location: Office Based but will travel region on visits to patients

This position is responsible care management activities including managing coordination of covered and non- covered benefits, care plan development and ongoing assessment and evaluation for MLTC membership. The Care Manager will be responsible to manage a case load of 65 members and will include the need for telephonic and home visits to engage members in care. Care Managers are required to have their own reliable method of transportation. Each Care Team will manage up to 130 members. The Care Team is made up of 2 Care Managers and 1 Care Coordinator. The Nurse Case Manager will work within the team to assure that the needs of the individual patients get addressed in a timely, efficient, yet patient centric manner.
She/he will lead the weekly case conference meetings on their own members, where individual cases will be discussed and Care Plan will be modified. All Care Managers are required to complete rotating shifts for on-call clinical support to the MLTC members. The Case Manager will work cross functionally, as needed, to access other resources available within the assigned region. The assigned region and responsibilities may change, depending on operational need.

A. Technical/Service
Performs daily review of care needs for MLTC Members receiving care and services in accordance with established clinical guidelines and in the most appropriate care setting

Keeps current with regulation changes and informs the Care Team staff of all up-dates and changes.

Completes self - evaluations and is an active participant in performance evaluations.

Works collaboratively with other departments in the development and evaluation of projects.

Collaborates with the healthcare team to arrange for identified needs.

Conducts Utilization Management determinations in accordance with Article 49-Utilization Review

Ensures collection and review of required documentation such Semi Annual Assessment of Members.

Reviews clinical documentation, claims/utilization data to ensure members are receiving appropriate care and implement strategies to address unmet needs as appropriate

Provides direction and support to the Care Coordinator, Member and any other supporting staff, to ensure timely collection of data, ongoing provider and member outreach and documentation of outreach activities and outcomes.

Reviews and updates policies and procedures.

Participates in comprehensive, interdisciplinary care planning.

Educates providers and members regarding Plan benefits, policies, and Article 49-Utilization review process

Ensures member confidentiality and adheres to Confidentiality and HIPAA policies and regulations.

Performs other duties as assigned by the Director & Manager of Care Management and/or Medical Director.

B. Organizational/ Managerial

Is punctual and maintains a satisfactory attendance record.

Is appropriately attired for the office and/or community locations.

Demonstrates reliability and trustworthiness.

Effective in taking action without being asked (takes initiative).

Manages time and other resources to meet established goals within the agreed upon time frames.

Demonstrates flexibility in the acceptance and completion of work assignments.

Maintains member confidentiality in the management of information.

Contributes to a cooperative, friendly and mutually supportive work environment: a "team" player.

C. Educational/Professional Development

Participates in the development of other staff members.

Identifies learning strengths and needs.

Utilizes learning resources.

Maintains cultural competence.

D. Communication/Relationships

Demonstrates ability to communicate effectively in different settings and forums.

Displays courtesy, tact, and patience during interactions with members, providers, and clients.

Answers telephones in an appropriate, professional manner, and resolves problems in a reasonable time frame.

Assists clients/members/providers in solving particular problems and refers the client/members/providers to Director if it cannot be handled to the client's satisfaction.

Demonstrates a high level of energy, enthusiasm and self-motivation.

Demonstrates a solution-focused approach.

Demonstrates a creative, articulate approach and maintains cultural competency.

The successful candidate will have at least 1 to 3 years of experience in care management, preferably in long term care, either at a health plan, an integrated delivery system, hospital system, IPA, medical group or health plan.

Associates or Bachelor's Degree in Nursing
Unrestricted license in the State of New York
Minimum of two (2) years of prior health care or managed care experience
Team player and demonstrated ability to be a team leader
Minimum of two (2) years of long term medical or chronic care experience
Demonstrates knowledge in Case Management
Knowledge of Article 49-Utilization Review Process
Demonstrates judgment of safety and confidentiality issues
Demonstrates strong verbal/written communication and customer service skills
Demonstrates computer proficiency, including but not limited to Word and Excel

Independent Living Systems, LLC is committed to protecting the safety, health and well-being of all employees and individuals in our workplace. We believe that alcohol abuse and illegal drug use are detrimental to achieving success as an individual and as a professional. Employment at ILS is contingent upon successfully passing a pre-employment drug test prior to start date. We are proudly a drug and alcohol free workplace and will maintain to enforce such policy. Our drug and alcohol free workplace policy is intended to apply whenever anyone is representing or conducting business for ILS.

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