RN Care Manager

Elderwood; Buffalo (NY); Hybrid; USD 82,800 - 101,200; Full time

Benefits offered by this job

Remote working options

Medical, Dental & Vision benefits

401(k) retirement plan with employer 4

Free Parking

Job summary

Elderwood IPA in Buffalo, NY is seeking a Registered Nurse Care Manager to assess members’ home health and care needs, coordinate services, and support member-centered service plans. The role involves working with a Social Worker to facilitate the MLTC care model and ensure timely access to covered services.

Responsibilities include assessment, planning, facilitation, and advocacy to meet home health needs, documentation in EMR, and participation in utilization and quality improvement

Qualifications

• BSN, AAS Degree or nursing diploma and Case Management Certification preferred.
• Current New York State Registered Nurse License required.
• Valid NYS Driver’s license required.
• Minimum of three years nursing experience in home care, case management, discharge planning or managed care.
• Minimum of one year experience with elderly population.
• Minimum one year experience with health assessments.
• Ability to focus on disease processes and plan patient-centered care.
• Familiar with governmental and accrediting agency health plan requirements.
• Familiar with applying clinical criteria for medical necessity.

Responsibilities

• Provide care management through assessment, planning, facilitation, and advocacy to meet home health needs.
• Develop and maintain a person-centered service plan based on needs assessment.
• Participate in utilization review and determine eligibility for services or denials.
• Refer members to social work or other professionals for estate planning and related services.
• Ensure documentation meets professional standards using an EMR across interactions.
• Identify early signs of problems and initiate interventions to prevent care escalation.
• Participate in Disease Management, Utilization Management, and Quality Improvement activities.
• Use UAS-NY assessment tools; training available.
• Utilize standard instruments such as PRI, UAS-NY.

Skills

Home health nursing

Care coordination

Assessment skills

Documentation

HIPAA compliance

Education

BSN / AAS / Diploma in Nursing

Case Management Certification

New York State RN License

Valid NYS Driver’s license

Tools

EMR

Microsoft Office 365

Job description

Overview

In the role of an Registered Nurse Care Manager (RN Care Manager), you are a critical resource for our members as you are responsible for assessing member’s home health and level of care needs, assisting them in accessing necessary covered services, providing referrals and coordinating other medical services in support of their member centric service plan.

Salary

Starting at 92,000 / Yr

Why join Elderwood IPA?

• Voted Buffalo Business First Best Places to Work 2020 & 2021!
• Monday-Friday Schedule w/ no weekends or overnights
• Remote working options
• Medical, Dental & Vision upon 1st of month following 60 days of hire
• 401(k) retirement plan with vested employer match up to 4%
• Free Parking & convenient parking

Join Our Team

Join our strong and growing company today!

Responsibilities

The RN Care Manager assists our members with obtaining needed medical, social, educational, psychosocial, financial, and other services. You will partner with a Social Worker to facilitate the MLTC care model by coordinating services and community resources and meeting the members socioeconomic needs to support the quality of life.

• Provide a care management process of assessment, planning, facilitation, and advocacy for options and services to meet a member’s home health needs through collaboration, communication, and available resources, while promoting quality cost-effective outcomes.
• Developing and maintaining a person-centered service plan based on a needs’ assessment identifying the strengths, capacities, preferences and long-term goals of the Member, resources available to meet member needs and ongoing revisions to the service plan based on the changes in the Member’s condition and status.
• Participating in the utilization review process and evaluating to determine if the member’s condition and needs meet criteria for covered services and provide service prior authorization or denials to health care providers.
• Review financial, legal, or medical issues and refer Members to social work or other professionals for estate planning, living wills, family trust, crisis services, and other programs.
• Ensure that documentation in the care management record meets all applicable professional standards, using an EMR for each observation, verbal report, or interaction with the Member, Member’s caregiver/family, PCP or other provider, whether by home visit, telephonic, or written interaction.
• Early identification of incipient problems or significant changes in Member conditions to initiate early intervention and strategies to prevent or more quickly treat chronic care exacerbations.
• Participate in Disease Management, Utilization Management, and Quality Improvement activities.
• Competently use the UAS-NY assessment tool. Previous UAS-NY is desired, but not required. Training is available.
• Use of standard patient assessment instruments such as PRI, UAS-NY.

Qualifications

• BSN, AAS Degree or diploma in Nursing and Case Management Certification is preferred
• A current New York State Registered Nurse License (Required)
• A valid NYS Driver’s license (Required)
• Minimum of three (3) years nursing experience in home care, case management, discharge planning or managed care
• Minimum of one (1) year experience working with a frail or elderly population
• Minimum one year experience with health assessments
• Ability to focus on specific disease processes/health issues and identify strategies to promote client focused care planning
• Familiarity with provisions of governmental and accrediting agency health plan requirements.
• Familiar with applying clinical criteria when determining medical necessity and/or benefit administration.
• HIPAA Privacy
• Computer skills, including working knowledge of Electronic Medical Records (EMR), Microsoft Office Suite (365).

Additional Requirements

• Must have a safe driving record. A DMV motor vehicle report will be reviewed.
• Must be in good standing with the Medicare and Medicaid programs. This includes a criminal background check.
• Possess good speaking and listening skills.
• Bilingual skills (prefered)
• Must be free of communicable disease.

This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.

Equal Opportunity Employer Statement

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.