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Rn - Ltss Care Manager - Remote

Company

EmblemHealth
Address , New York, Ny
Employment type
Salary $125,000 - $235,000 a year
Expires 2023-10-06
Posted at 8 months ago
Job Description
Summary of Position
  • Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members’ health care needs, identifying gaps in care and needed support, administering/coordinating implementation of interventions.
  • Provide Care Management services to identified high risk members within the community, including but not limited to Physician Practices, Retail Centers/Neighborhood Care Centers, and members’ homes.
  • Coordinate and provide care that is safe, timely, effective, efficient and member-centered to support population health, transitions of care, and complex care management initiatives.
  • Support and enable members to manage their physical, environmental and psycho-social concerns, understand and appropriately utilize their health plan benefits and remain safe and independent in their home or current living environment in collaboration with health care providers.
  • Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate and timely utilization of services across the continuum of care.
  • Assist the entire Care Management interdisciplinary team in managing members with Care Management needs.
Principal Accountabilities
  • Include member and family as appropriate.
  • Identify appropriate goals, strategies and interventions that may include referrals, health education, activation of community-based resources, life planning, or program/agency referrals based on areas of concern.
  • Work collaboratively with all stake holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences when appropriate.
  • Maintain an understanding of Care Management principles, program objectives and design, implementation, management, monitoring, and reporting.
  • Act as the member’s advocate and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies.
  • Enter and maintain documentation in the Electronic Medical Records System (EMR), meeting defined timeframes and performance standards.
  • Coordinate interdisciplinary team tasks and activities, with the goal of maintaining team performance and high morale.
  • Provide ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care.
  • Perform other related projects and duties as assigned.
  • Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making care management recommendations.
  • Assess the needs of members and align them with the appropriate member of the care team (wellness team, registered dietitian, social worker, community health workers).
  • Develop, implement and coordinate plan of care and facilitate members’ goals.
  • Assess and evaluate the needs of our most complex members, acting as the clinical coordinator collaborating with members, caregivers, providers, multi-disciplinary team, and health care and community resources through a variety of assessments to identify areas of (medical, financial, environmental, health insurance benefit, psycho-social, caregiving) concerns and potential gaps in care utilizing the most appropriate resources to support members’ needs.
  • Engage actively with the member PCP / designee.
  • Ensure that all Care Management processes and reporting are compliant with all applicable federal and state regulations, and NCQA and company standards.
  • Attend and complete all department-mandated training as well as satisfy educational in-service requirements.
  • Actively participate on assigned committees.
  • Develop, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high quality, cost effective continuum of care with the member, caregiver, provider(s) and multidisciplinary team.
  • Engage with the member in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes for member.
  • Participate in delegation collaboration activities, as required.
Education, Training, Licenses, Certifications
  • RN required, with current active RN license.
  • Certification in utilization or care management preferred.
  • CCM certification preferred.
  • Bachelor’s degree.
Relevant Work Experience, Knowledge, Skills, and Abilities
  • Trained in the use of Motivational Interviewing techniques. (P)
  • System user experience in a highly automated environment. (R).
  • 4 – 6 years of clinical experience. (R)
  • Experience in case management/care coordination, managed care, and/or utilization management. (P).
  • Organization/prioritization ability; and the ability to effectively manage a caseload of highly complex members. (R)
  • Strong communication skills (verbal, written, presentation, interpersonal). (R)
  • Ability to work a flexible schedule (evenings, weekends and holidays) to meet member and/or caregiver and departmental
  • Bilingual ability (verbal, written). (P)
  • Support an integrated care model tapping into appropriate resources both internally and external to the organization. (R)
  • Strong cross-group collaboration, teamwork, problem solving, and decision-making skills. (R)
  • Experience working in medical facility or practice and/or with electronic medical records. (P)
  • Scheduling needs. (R)
  • Computer proficiency: MS Office (Word, Excel, Powerpoint, Outlook); mobile technology (wireless phone/laptop, etc.) (R)

Additional Information

  • Requisition ID: 1000000822
  • Hiring Range: $125,000-$235,000