Case Manager

Role Overview

• responsible for helping members achieve a level of well-being, to avoid preventative hospital admissions or readmissions through the administration of quality improvement functions
• perform telephonic outreach to members, physicians, or other care givers to develop a plan of care for the member who needs CM services
• perform case management functions using a member-centric, collaborative process to optimize the wellness and functional capability of members
• adhere to regulatory and compliance requirements, adhere to department productivity and quality metrics
• conduct comprehensive assessments of the member’s health and psychosocial needs
• identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs
• document the patient’s plan of care in a timely manner

Requirements

• Registered Nurse (RN) with active, current, unrestricted NYS license
• licensed master social worker (LMSW)
• master’s in social work (MSW)
• licensed dietician with case management experience required
• Case Management Certification (CCM) required
• Two (2) years of case management or clinical experience in acute medical/surgical/critical care or ambulatory setting required
• Proficient computer and Windows skills required, including MS Office
• Previous clinical experience in a managed care setting as a case/care manager preferred
• Clinical knowledge of the health and social needs of the population served
• Ability to identify barriers to a successful case management path
• Excellent critical thinking and time management skills
• Excellent written, verbal, and interpersonal communication skills with ability to provide exceptional customer service to external and internal customers to include telephonic interviewing of members; motivational interviewing skills a plus
• Transferable knowledge, skill, and ability to complete job duties independently and proficiently
• Flexibility in work schedules and assignments required. Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Benefits

• full range of benefits
• generous paid time off
• scorecard incentive