The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
Requires a New York state RN with unrestricted & active
Job Responsibilities:
- 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
- Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
- Provides evidence-based disease management education and support to help the member achieve health goals.
- Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.
- Provides care coordination to support a seamless health care experience for the member.
- Meticulous documentation of care management activity in the member’s electronic health record.
- Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
- Identifies and connects members with health plan benefits and community resources.
- Meets regulatory requirements within specified timelines.
Skills:
- Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role.
- Minimum 3+ years of nursing experience
- Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience
- Experience providing care management for Medicare and/or Medicaid members.
- Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
- Experience conducting health-related assessments and facilitating the care planning process.
- Bilingual skills, especially English & Spanish
Education/Experience:
- Associates of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
- Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY. Additional licensure is preferred but not required. NY is not a compact state, single state licensure for NY is required.
- Bachelor of Science in Nursing (BSN) (PREFERRED)
