RN Care Manager – Occasional – Days Position Available In Bronx, New York

Job Description:

Job Summary The Care Manager is responsible for completing acomprehensive assessment to determine the correct services andbenefits based on medical necessity for an enrollee. Provides planeducation, transition of enrollees to clinical services based onDepartment of Health (DOH) guidelines. Care management providingadvocacy, coordination and oversight of all healthcare services foran enrollee striving to deliver the best care at the right time andin the most-cost effective while meeting quality outcome standardsfor the enrollee case load assigned. Complies with all state andfederal regulations including Health Insurance Portability andAccountability Act (HIPAA). Core Job Responsibilities Identifiesand coordinates enrollee services as provided by the plan andservices that are not a benefit of the plan (Medicare Services).Completes comprehensive assessment using the DOH approved tool todetermine eligibility of medically necessary services. Educates andcompletes with enrollee all necessary consents and documentation.

Initiates and carries out continuous assessment of physical,emotional, social, cultural, economic, and environmental needs ofthe enrollee and coordinates services for needs as determined.

Observes the enrollee for changes in condition and follows up withappropriate services or providers to attempt to prevent diseaseexacerbations. Develops, monitors and revises a Plan of Care withthe enrollee or enrollee’s designee that has problem, enrolleecentered goals and interventions. Implements orders for DurableMedical Equipment items and treatments as prescribed by thephysician, submitting and maintaining appropriate medical ordersand documentation. Completes documentation per companystandards/policy utilizing an Electronic Medical Record (EMR)system. Participates in Marketing Activities as requested byExecutive Director or Designee. Accepts assignments and performsduties within their nursing scope of practice, seeking andobtaining sufficient information/education necessary to functioneffectively in the managed long term care setting. Participates indepartmental and organizational committees and meetings asapplicable. Participates in the orientation of new staff, mentorspeers, and promotes collaborative teamwork. Performs all duties andresponsibilities in accordance with the Nurse Practice Act and inaccordance with the basic principles of professional nursing.

Maintains a working knowledge of, and adheres to applicablefederal/state regulations including, but not limited to, patientconfidentiality, release of information, and HIPAA. Performs otherrelated duties as requested by the Executive Director or ClinicalServices Manager. Clarifies issues and actively addresses concernsin a timely manner. Ability to manage conflict, stress, andmultiple simultaneous work demands in an effective, professionalmanner. Ability and willingness to self-motivate, prioritize, andbe willing to change processes to improve effectiveness efficiency.

Adapts to changing enrollee or organizational priorities. Abilityto make independent decisions in accordance with establishedpolicies and procedures. Performs related duties as assigned.

Education/Experience Requirements

REQUIRED

Computer literacy,including but not limited to data entry, retrieval, and reportgeneration. Excellent written, verbal and listening communicationskills. Strong organizational and time management skills. Abilityto work with patients/families of all ages and in a variety ofsettings, including inpatient facility and patients’ homespresenting diverse physical conditions and social/culturalenvironments. Ability to drive to and from a variety of settings invarying weather conditions.

PREFERRED

1-2 years in community basedcare or health care area that cares for the community population.

Licensure/Certification Requirements

REQUIRED

Licensed andcurrently registered to practice as a Registered Professional Nurseor BSN in New York State, with preferred 1-2 years in communitybased care or health care area that cares for the communitypopulation. Valid New York State driver’s license and personalvehicle. Current Basic Life Support (BLS) Certification. DisclaimerQualified applicants will receive consideration for employmentwithout regard to their age, race, religion, national origin,ethnicity, age, gender (including pregnancy, childbirth, et al),sexual orientation, gender identity or expression, protectedveteran status, or disability. Successful candidates might berequired to undergo a background verification with an externalvendor. Job Details Req Id 92326 Department

CARE MANAGEMENTSERVICES

Shift Days Shift Hours Worked 8.00 FTE 0.19 Work Schedule

HRLY NON-UNION-8 HR

Employee Status A7 – Occasional Union Non-UnionPay Range $31 – $45 Per Hour