Care Manager - New York, NY (Hybrid)
Position type: Contract - Fulltime
Duration: 3+ Months
Location: New York, NY
As a Care Manager you will be doing:
Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business.
Develop a working relationship with the PCP to be able to contact and discuss the care of the members with them.
Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team.
Identify the risk factors and assign the risk category to the member.
As part of Care Management team, we develop a formal care plan for all services needed for the members, including the members’ disaster plan.
Monitor the condition of all members at least monthly, typically by telephone but via face‑to‑face when necessary.
Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care.
Prior approve request for additional services based on assessments and using evidence‑based standards refer denial, reduction, or limitation of service request to Medical Director.
Assist members with the coordination of services both within and outside networks as appropriate. Includes facilitating discharge from acute settings and alternate settings.
Provides Care Coordination through continuum of care.
Optimizes both the quality of care and the quality of life for the members.
Coordinate with Utilization Management (UM) department on concurrent and retrospective review.
Follow up with assigned nurses for clinical updates to care plan.
Document within two business days’ coordination notes and routine contacts with the members according to the level of risk assigned to them.
Participate in team care planning meetings.
Handling complaints that can be resolved in one day.
Assists Customer Service and the UM department by providing records and materials needed for grievances from MLTC/MAP program members.
Speaks to members who are delinquent in their spend‑down payments.
Cooperate with all departments.
Identifies members appropriate for specialty programs.
Performs all MLTC/MAP management activities in compliance with all regulatory agency requirements.
Provides information on all requests from Quality Management Department to be reviewed by the various Quality committees.
Completes all other tasks assigned by MLTC Department Leadership.
Participate in the department on call schedule/being on call, which is rotated amongst the care team.
Qualifications (Must Haves):
Baccalaureate degree required.
PRI and Screen certification within three months of employment is required.
Master’s Degree and Bilingual Spanish Certification in Case Management preferred.
License Requirement:
RN Licensed as a Registered Nurse in the State of New York required.
The ideal candidate will have: Five years minimum of clinical experience as a Registered Nurse. Experience with Care Coordination, Utilization review and discharge planning. Computer literacy required.
Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
Pay Range: $60 per hour - $65 per hour
Benefits: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health savings account (HSA), Flexible spending account (FSA), Life Insurance, Pet Insurance, Short‑term and Long‑term Disability, Accident & Critical illness coverage, Pre‑paid legal & ID theft protection, Sick time, Employee Assistance Program (EAP).
Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are a person with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed.