• RN Care Manager- MLTC

    Job Locations US-NY-Staten Island
    ID 2018-1040
    Category
    Clinical- MLTC
    Type
    Regular Full-Time
  • Overview

    RN Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate long-term care services for Extended MLTC members through assessment and member-centered care planning, direct provider coordination and collaboration to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.

    Responsibilities

    • The RN Care Manager plans, implements, manages and evaluates the provision of services to ensure that all members’ needs are met and quality care is provided in accordance  with Federal, State and Agency guidelines.
    • Maintains a case load as per DOH-approved Extended MLTC policy.
    • Assigns administrative tasks to Member Care Associates, provides instructions and oversees completion of assigned tasks.
    • Using the UAS assessments and interviews done by the Enrollment Nurses, identifies the risk factors, strengths and challenges, service needs of the member to keep him/her in their community setting.
    • Establishes and updates the care plan with input from the member, caregiver(s), physician and other multidisciplinary health team members.
    • Assist members with coordination of services both in-network and out of network as appropriate, including facilitating discharge from acute setting and alternate settings.
    • Educates members and caregivers about disease process and recommends interventions to improve outcomes.
    • Ensures open flow of communication between providers, community-based teams and telephonic care coordination efforts.
    • Collaborates with other care coordination and community health programs/teams to ensure that all care management interventions are aligned and consistent.
    • Creates and maintains member's electronic medical record. Completes all required documentation in a timely manner and according to agency policy, including care management and coordination notes, Plans of Care, interdisciplinary communications, incidents, complaints and grievances.
    • Manages the activities of the multidisciplinary team providing care to members as well as ensures that all services scheduled and provided are authorized and ordered by a physician (if applicable)
    • Reviews reports, evaluates ongoing members care needs and communicates those needs to the physician. 
    • Maintains proficiency in clinical and administrative skills
    • Demonstrates sound judgment and independent problem solving skills in order to initiate appropriate intervention with regard to member's psychosocial and/or physical impairment.
    • Facilitates the care of the member in the home setting by utilizing appropriate community resources, counseling and teaching member and member's family and advocating on behalf of the member.
    • Communicates member care issues to the Clinical Manager.
    • Develops, implements, and carries out a discharge plan in conjunction with the member, caregiver and members of the health care team.
    • Interprets agency policy to member and member's family.
    • Promptly addresses complaints that can be resolved in one day
    • Assists Member Services, and QA/UM departments by providing records and materials needed for timely resolution of grievances.
    • Participates in performance improvement activities, team meeting and orientation as requested.
    • Demonstrates sound judgment by taking appropriate actions regarding suspected violation of corporate compliance regulations.
    • Reports all suspected violations to supervisor, Compliance Officer or Compliance Hotline.
    • Travels to other Extended’s office locations as needed.
    • Performs telephonic on-call duties as needed after working hours, on weekends and holidays.
    • Performs other duties as needed or assigned.

    Qualifications

    • Current NYS RN License required
    • Bachelor’s degree in Nursing is preferred
    • Minimum of 1 year recent nursing experience required
    • MLTC Home Care experience preferred
    • Strong verbal/written communication skills
    • Basic knowledge of Excel and Microsoft Word

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