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Job DescriptionJob Description
Position Title: Care Manager RN
Location: New York on site in Albany (Must permanently reside in New York State)
Position Type: Full-Time
Reports To: Care Management Supervisor
Position Summary: The Care Manager is responsible for coordinating and managing care services for members of a Managed Long-Term Care Service. This role involves working closely with patients, families, and healthcare providers to ensure that members receive comprehensive, individualized care that meets their long-term care needs. The Care Manager will use a holistic approach to assess, plan, implement, and evaluate care services, ensuring compliance with health plan policies and regulatory requirements.
Key Responsibilities:
Conduct comprehensive assessments of members’ health, functional, and psychosocial needs to develop individualized care plans.
Review and evaluate NY UAS information for members in the MLTC line of business.
Coordinates and manages care services across multiple providers and settings, including home care, community resources, and healthcare facilities.
Facilitate communication between members, families, and healthcare providers to ensure continuity of care and address any issues or barriers.
Assesses and monitors the condition of the members via monthly calls.
Identify clinical issues that require immediate attention to reduce the risk of unnecessary hospitalizations.
Develop, implement, and regularly review care plans in collaboration with members, families, and multidisciplinary teams.
Monitor and evaluate the effectiveness of care plans, adjusting as needed to meet changing member needs and goals.
Timely and thorough documentation in the health record.
Participates in weekly Interdisciplinary Care Team Meetings.
Provide guidance and support to members and families on navigating the healthcare system and accessing appropriate services. Participates in family conferences, as needed. Ensure care management activities comply with health plan policies, state and federal regulations, and accreditation standards.
In collaboration with the Transition of Care Team, facilitates the discharge plan from the hospital or other alternate settings.
Coordinates services in collaboration with the utilization management department
Track and report on care outcomes, quality metrics, and member satisfaction to identify areas for improvement and implement best practices.
Conduct audits and reviews of care plans and services to ensure quality and compliance. Identify and utilize community resources and services to support members' needs and enhance their quality of life.
Advocate for members to access necessary services and benefits, including long term care services, medical equipment, and support services. Manage and monitor care budgets and expenditures to ensure cost-effective use of resources.
Provide education and support to members and families on disease management, care options, and self-care strategies.
Offer training and guidance to other care team members on best practices in care management and coordination.
Qualifications:
Education: Bachelor’s degree in nursing, master’s degree or advanced certification.
Bilingual a must (ENGLISH and other)
Licensure/Certification: Active & in good standing NYS RN license
Experience: Minimum of 2 years of experience in case management, care coordination, or a related field, preferably in a managed care or long-term care setting, a plus
Strong knowledge of long-term care services, healthcare systems, and regulatory requirements is a plus
Excellent interpersonal, communication, and problem-solving skills.
Proficiency in care management software, electronic health records (EHR), and other relevant technologies.
Ability to work independently and as part of a multidisciplinary team.
Work Location: Remote Physical Requirements:
Prolonged periods of sitting at a desk and working on a computer.
Must be able to carry, lift, push or pull at least 20lbs
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