Case Manager, RN (Medicare)

Case Management Program Coordinator

Conducts case management program activities in accordance with departmental, corporate, NYS Department Of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources.

Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers.

Essential Accountabilities:

• Handles physical health member clinical management programs.
• Maintains knowledge of current Case Management Society Of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable.
• Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,
• Maintains confidentiality and conducts information management procedures per corporate and departmental policy.
• Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews.
• Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services.
• Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals.
• Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena.
• Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits.
• Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment.
• Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources.
• Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist
• Accepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable.
• Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications.
• Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care.
• May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA).
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• May participate in the orientation of new staff.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• Associates degree required. Bachelor's degree preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required.
• Minimum of three years of clinical experience required. Case Management experience preferred.
• Must demonstrate proficiency with the Microsoft Office Suite.
• Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Must demonstrate ability to work independently on a daily basis.
• Deliver efficient, effective, and seamless care to members.
• For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB.

Physical Requirements:

• Ability to travel and work long hours on a computer.
• May require flexible hours to meet needs of member discussions.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply.

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits.

Equal Opportunity Employer

Compensation Ranges:

• Level I: Grade E2: Minimum $60,410 - Maximum $96,081
• Level II: Grade E3: Minimum $60,410 - Maximum $106,929
• Level III: Grade E4: Minimum $65,346 - Maximum $117,622

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.