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Job Requirements of Registered Nurse (RN) - Care Manager:
-
Employment Type:
Contractor
-
Location:
New York, NY (Onsite)
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Registered Nurse (RN) - Care Manager
Careers Integrated Resources Inc
New York, NY (Onsite)
Contractor
Job Title: Registered Nurse (RN) - Care Manager
Job Location: New York, NY 10004
Job Duration: 2- 3 Months (Possibility of extension)
Shift time: 8 AM TO 4 PM/ 9 AM to 5 PM
Pay - $60/hr. - $65/hr. on w2
Note: We have openings for Manhattan/ Brooklyn/ Bronx/ Queens (choose any location, shift, department as per experience)
Position Overview:
Role & Responsibilities:
- 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 member 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, develops a formal care plan for all services needed for the member, including the member’s 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 setting 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 day’s coordination notes and routine contacts with the members
- according to the level of risk assigned to them.
- Participate in team care planning meetings.
- Handles complains 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.
- Cooperates with all department within
- 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.
- Participates in the department on call schedule/being on call, which is rotated amongst the care team.
Skills:
- Minimum of five (5) years of clinical experience as a Registered Nurse
- Leadership experience preferred
- Experience in: Care Coordination, Utilization Review, Discharge Planning
- Computer literacy required
- Bilingual Spanish Certification in Case Management
Education & Licensure:
- Licensed Registered Nurse (RN) in the State of New York (required)
- Baccalaureate degree (required)
- PRI and Screen certification required within three (3) months of employment
- Preferred Qualifications: Master’s Degree
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