In-Home Geriatric Care Manager (RN) & Advocate

CareSource Management Services; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

CareSource Management Services is seeking a Nurse Care Manager to provide care coordination, including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet members' health needs while promoting quality, cost-effective outcomes.

The role involves assessing member needs, authorizing services, coordinating with primary care providers and the interdisciplinary team, performing home visits, and developing patient-centered care plans across hospital,

Qualifications

• Associates degree in Nursing from an accredited nursing program required.
• Bachelor's degree in Nursing preferred.
• Two (2) 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.

Responsibilities

• Assess and monitor members' needs and status.
• Authorize covered services and coordinate care.
• Collaborate with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
• Work with member/family to maintain the most independent living situation possible.
• Assess, plan and provide continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
• Regularly assess members for ongoing eligibility for services based on the specific plan's eligibility criteria.
• Perform 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 and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
• Responds to members' requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated
• Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.
• Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.
• Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members' needs.
• Perform any other job related duties as requested.

Skills

Microsoft Office

Communication

Multitasking

Healthcare regulations

Ethics

CMSA standards

Advocacy

Cultural sensitivity

Research literacy

Community resources

Critical thinking

Time management

Bilingual

Education

Associates degree in Nursing

Bachelor's degree in Nursing

Job description

CareSource Management Services is seeking a Nurse Care Manager to provide care coordination, including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet members' health needs while promoting quality, cost-effective outcomes.

The role involves assessing member needs, authorizing services, coordinating with primary care providers and the interdisciplinary team, performing home visits, and developing patient-centered care plans across hospital,