Registered Nurse, Care Manager - Bronx/Westchester

Role Overview

• Provides care coordination, including in-home assessment, planning, facilitation, advocacy, and authorization of covered plan services
• Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status
• Authorizes covered services and coordinates care regardless of payer
• Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team
• Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs
• Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member
• Ensures appropriate, safe plan for members’ discharge from their plan
• Identifies same day grievances, investigates and documents accordingly
• Identifies members requiring Care Management Review (CMR) and evaluates documentation provided by the IDT
• Develops efficient plans of care, authorizing only needed services at the most appropriate levels

Requirements

• Associates degree in Nursing required
• Bachelor's degree in Nursing preferred
• Three (3) years of experience as a registered nurse required
• Clinical experience in geriatrics and/or managed long-term care experience preferred
• Experience using multiple languages may be required based on operational needs
• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
• Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
• Bilingual speaking and writing skills are preferred.

Benefits

• Comprehensive total rewards package
• Bonus tied to company and individual performance