Overview RN Clinical Care Manager/Case Manager - New York
The RN Clinical Care Manager/Case Manager is responsible for developing and maintaining long-term relationships with physicians, physician office staff, and Healthmap members engaged in Healthmap’s Kidney Management Program through coordinating performance improvement activities and care management to improve health outcomes.
Responsibilities Act as a liaison between Healthmap, provider practices and Healthmap members to ensure positive engagement and performance with our program(s).
Develop new provider/partner business relationships to enhance Healthmap provider and member engagement and manage assigned caseload.
Identify opportunities to improve health outcomes for Healthmap Solutions members based on provider-specific data.
Incorporate education and communication on best practice sharing, process improvement in provider workflows, Kidney Health Management interventions and HEDIS/STAR measures for identified areas of provider low performance.
Educate provider offices on topics related to Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, etc.
Partner with physicians/physician staff to identify Healthmap Solutions members who would benefit from Care Navigation support, conduct outreach, and engage members in the program.
Educate Healthmap members on kidney health, related co-morbid conditions, and renal replacement therapy.
Serve as Healthmap member advocate, utilize community resources and programs, and act as liaison between the member, their support network, treating physician, and ancillary providers to help members meet individualized goals.
Accountable for individual and departmental metrics and key performance indicators as identified by the organization.
Ensure timely and successful delivery of reports to internal and external stakeholders.
Maintain thorough documentation of all provider meetings/interactions and member interactions for consistency and coordination and in compliance with NCQA standards.
Ensure Healthmap policies and procedures are followed and compliant with HIPAA privacy laws and all other regulations.
Perform other related duties as assigned.
Requirements Bachelor’s degree required.
Active, unrestricted RN license required.
Basic Life Support (BLS) certification required.
Advanced Cardiovascular Life Support (ACLS) certification (based on role).
3+ years of progressive experience in healthcare services, clinical operations, quality, or care management.
3 years of experience in care gap closure or care coordination activities, including outpatient or hospital settings (preferred).
Prior experience building and managing relationships with health care providers or patients (preferred).
Proof of valid and unrestricted driver’s license required; regular travel within assigned region is required.
Must reside in one of the assigned states.
Must comply with organization policies for health screening and immunizations, including: current TB test or chest X-ray, proof of immunizations (e.g., Hepatitis B, MMR, Varicella, COVID-19, Influenza), and participation in annual health and wellness screenings.
Skills Excellent verbal, written and presentation skills.
Interpersonal skills to develop and maintain strong internal and external relationships.
Ability to multitask, prioritize, and create solutions in a fast-paced environment.
Demonstrated leadership skills and ability to foster a positive work environment.
Strong critical thinking and analytical skills.
Ability to foster strong employee engagement among the team.
Proficiency in Microsoft Office: Outlook, Word, Excel, PowerPoint.
Bilingual preferred: Spanish, Creole, and/or Mandarin.
Additional information Travel: Heavy travel (>50%) across the assigned region.
Compensation: Base pay range $114,000 - $143,000 per year, plus bonus eligibility.
Benefits: Competitive benefits including Paid Time Off, Medical, Dental, Vision, Short Term/Long Term Disability, 401K with match and other voluntary benefits as elected.
Job level & type Mid-Senior level
Full-time
Job function & industries Health Care Provider
Hospitals and Health Care