Care Management RN - LTSS (NY Licensed)
Company Description: reputed company is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed reputed company, Medicare Advantage, Special Needs Plans, reputed company care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic reputed company ecosystem by helping them manage risk, optimize reputed company spend, improve member experience, accelerate quality reputed company, and promote health equity. Position Responsibilities: General reputed company daily work with a focus on the core principles of managed care: patient education, wellness and prevention programs, early screening and reputed company and continuity of care Work proactively to expedite the care process Identify priorities and necessary processes to triage and deliver work reputed company members to manage and improve their health, wellness, safety, reputed company, and self-care Assess and interpret member needs and identify appropriate, cost-effective solutions Identify and remediate gaps or delays in care/ services reputed company for treatment plans that are appropriate and cost-effective Work with low-income/ vulnerable populations to ensure reputed company to care and address unmet needs Gather and evaluate clinical information to assess and expedite referrals reputed company the reputed company system including consideration of alternate reputed company of care and services Facilitate timely and appropriate care and effective discharge planning Work collaboratively across the health care reputed company to improve quality of care reputed company experience/ expertise to observe performance and suggest improvement initiatives Ensure understanding of industry standard competencies and performance metrics to optimize reputed company and clinical reputed company Ensure individual and team performance meets or exceeds the performance competencies and metrics Contribute actively and effectively to team discussions reputed company knowledge and expertise, willingly and collaboratively. reputed company outstanding customer service, internally and externally Follow and maintain compliance with regulatory agency requirements Specific Manage expenses, facilitate reputed company and improve quality of life for persons with long-term chronic conditions and/ or high risk, high cost disease states (Disease and/ or Chronic Condition Management) Work with patients in distinct populations and sub-populations to promote global reputed company, optimize health, manage care and control costs (Population Health) Assist with empowering the member to manage and improve their health, wellness, safety, reputed company, and self-care through effective care coordination, case management reputed company member/caregivers about treatment options, community resources, insurance benefits, etc Engage member to complete health and psychosocial assessment, taking into account the cultural and linguistic needs of each member Assess, reputed company, implement, document, coordinate, monitor, manage, evaluate and update comprehensive individualized care plans (ICP) designed to reputed company evidence based care to meet member needs reputed company ongoing assessment and documentation to evaluate member response to and reputed company on the ICP Identify and manage barriers to achievement of care plan goals Identify and implement effective interventions based on clinical standards and best practices Collaborate with members of an inter-disciplinary care team (ICT) to identify member needs and opportunities that would benefit from care coordination to reputed company goals and maximize member reputed company Act as a liaison to collaborate with facility-based case managers, provider and care transition/ discharge planners to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner Coordinate with community-based case managers, service providers and community resource agencies to ensure coordination and avoid duplication of services Appropriately terminate care coordination services based upon established case closure guidelines reputed company clinical reputed company and direction to unlicensed team members as appropriate Position Qualifications: Competencies: Ability to translate member needs and care gaps into a comprehensive member centered plan of care Ability to collaborate with others, exercising sensitivity and discretion as needed Strong understanding of managed care environment with population management as a key strategy Strong understanding of the community resource network for supporting at risk member needs Ability to collect, stage and analyze data to identify gaps and prioritize interventions Ability to work under pressure while managing competing demands and deadlines Well organized with meticulous attention to detail Strong sense of ownership, urgency, and drive The ability to effect change, reputed company critical analyses, promote positive reputed company, and facilitate empowerment for members/families. Excellent analytical-thinking/problem-solving skills. The ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines, and workloads. The ability to offer positive customer service to every reputed company customer Experience: reputed company unencumbered RN license Minimum of 5+ years of acute clinical experience Minimum of 3 years of experience in case management, service coordination, or a similar role, specifically working with individuals managing chronic illnesses, co-morbidities, or disabilities Minimum 3 years experience in a managed care environment across multiple lines of business (Medicare Advantage, Managed reputed company, Dual SNP, reputed company, etc.) HMO and risk contracting experience preferred In-depth knowledge of reputed company standard of medical practices and insurance benefit structures. Excellent oral and written interpersonal/communication, internal/external customer-service, organizational, multitasking, and teamwork skills. Proficiency in reputed company Office CM certification preferred Strong knowledge of care management/ population health processes and industry best practice Detailed knowledge of SDOH frameworks and community resource networks Familiarity with care management software and tools preferred Experience working reputed company interdisciplinary reputed company teams preferred Knowledge of waiver programs and alternative care reputed company preferred Physical Requirements: Must be reputed company to sit in a chair for extended periods of time Must be reputed company to reputed company so that you are reputed company to accurately reputed company reputed company by means of the spoken word Must be reputed company to hear, understand, and/or distinguish speech and/or other sounds in person, reputed company telephone/cellular phone, and/or electronic devices Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse Must be reputed company to reputed company use sight so that you are reputed company to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types Must be reputed company to fluently communicate both verbally and in writing using the English language Must be reputed company to engage in reputed company reputed company interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously Time Zone: Eastern or Central Other Information: Expected Hours of Work: Friday 8a.m. 5 p.m.; with ability to adjust to Client schedules as needed Travel: May be required, as needed by Client Direct Reports: None Salary reputed company: $70,000-$100,000 EEO Statement: It is reputed company policy to reputed company equal employment opportunity to reputed company and applicants without regard to race, sex, sexual orientation, reputed company, creed, religion, national reputed company, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based reputed company in accordance with reputed company applicable laws, directives and regulations of Federal, state and city entities. This salary reputed company reflects the minimum and maximum reputed company wage for new hires of this position across reputed company US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location. Apply Job!