Mobile RN Care Manager — Flexible Hours & Impact

CareSource; New York (NY); On-site; USD 100,000 - 135,000; Full time

Benefits offered by this job

Bonus potential

Total rewards package

Job summary

CareSource in New York is seeking a Nurse Care Manager to coordinate care across home, hospital, sub-acute and long-term settings. You will perform in-home assessments, plan care, authorize services, and advocate for members while ensuring quality, cost-effective outcomes.

You will travel regularly to member homes and care sites, collaborate with the IDT and PCP, and develop Patient Centered Service Plans. NY RN licensure and CMSA familiarity are preferred; bilingual skills are a plus.

Qualifications

• Associates degree in Nursing from an accredited nursing program 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

Responsibilities

• 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.
• Works with member/family to maintain the most independent living situation possible
• Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
• Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria.
• 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. Documents any grievance according to plan policy.
• 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

Effective communication

Multitasking

CMSA standards

Bilingual (preferred)

Education

Associate degree in Nursing

Bachelor's degree in Nursing preferred

Job description

CareSource in New York is seeking a Nurse Care Manager to coordinate care across home, hospital, sub-acute and long-term settings. You will perform in-home assessments, plan care, authorize services, and advocate for members while ensuring quality, cost-effective outcomes.

You will travel regularly to member homes and care sites, collaborate with the IDT and PCP, and develop Patient Centered Service Plans. NY RN licensure and CMSA familiarity are preferred; bilingual skills are a plus.