RN Care Manager - Hybrid NYC

EmblemHealth; New York (NY); Hybrid; USD 68,000 - 119,000; Full time

Job summary

EmblemHealth is seeking a registered nurse to provide care management as part of a multidisciplinary team in the New York area. Responsibilities include telephonic and in-person assessments, coordinating care, and implementing interventions to support high-risk members within the community.

The role requires an active NY RN license and 4–6+ years of clinical experience; CCM preferred. A hybrid work model includes remote days and in-person days at ACPNY locations.

Qualifications

• Active and unrestricted RN license required in NY state.
• CCM certification preferred.
• 4-6+ years of clinical experience (Required).
• Organization/prioritization ability; manage a caseload of highly complex members (Required).
• Experience in case management/care coordination, managed care, and/or utilization management (Preferred).
• Trained in Motivational Interviewing techniques (Preferred).
• Experience with electronic medical records (EMR) (Required).
• Computer proficiency: MS Office (Word, Excel, Powerpoint, Outlook) (Required).
• System user experience in a highly automated environment (Required).
• Bilingual ability (verbal, written) (Preferred).
• Strong cross-group collaboration, teamwork, problem solving, and decision-making skills (Required).
• Ability to work a flexible schedule (evenings, weekends and holidays) (Required).

Responsibilities

• Assess and evaluate needs of our most complex members with a multidisciplinary team.
• Identify goals, strategies and interventions based on concerns.
• Develop and evaluate medical management strategies for high-quality care.
• Include member and family as appropriate.
• Engage with PCP/designee and treatment team.
• Support adherence to the care plan and goals.
• Collaborate with stakeholders to ensure action plan clarity.
• Ensure care management processes meet regulations and standards.
• Enter and maintain EMR documentation.
• Participate in required training and committees.

Skills

RN license

CCM certification

Clinical experience

Bilingual ability

Motivational Interviewing

Tools

MS Office

Job description

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com .

Need Assistance Applying? EmblemHealth provides reasonable accommodations to individuals with disabilities throughout the application and hiring process. If you need an accommodation, please contact [e-mail] so we can support your request in accordance with applicable law.

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Requirement 2 days (Thursday & Fridays 8:00am-6:00pm) - ACPNY location at 115 Chambers St. New York, NY

Monday, Tuesday & Wednesday work from home

Summary of Position

Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members’ health care needs, identifying gaps in care and needed support, administering/coordinating implementation of interventions. Support and enable members to manage their physical, environmental and psycho-social concerns, understand and appropriately utilize their health plan benefits and remain safe and independent in their home or current living environment in collaboration with health care providers.Provide Care Management services to identified high risk members within the community, including but not limited to Physician Practices, Retail Centers/Neighborhood Care Centers, and members’ homes.Coordinate and provide care that is safe, timely, effective, efficient and member-centered to support population health, transitions of care, and complex care management initiatives. Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate and timely utilization of services across the continuum of care. Assist the entire Care Management interdisciplinary team in managing members with Care Management needs.

Principal Accountabilities

• Assess and evaluate the needs of our most complex members, acting as the clinical coordinator collaborating with members, caregivers, providers, multi-disciplinary team, and health care and community resources through a variety of assessments to identify areas of (medical, financial, environmental, health insurance benefit, psycho-social, caregiving) concerns and potential gaps in care utilizing the most appropriate resources to support members’ needs.
• Identify appropriate goals, strategies and interventions that may include referrals, health education, activation of community-based resources, life planning, or program/agency referrals based on areas of concern.
• Develop, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high quality, cost effective continuum of care with the member, caregiver, provider(s) and multidisciplinary team.
• Include member and family as appropriate.
• Engage actively with the member PCP / designee.
• Engage with the member in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes for member.
• Work collaboratively with all stake holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences when appropriate.
• Assess the needs of members and align them with the appropriate member of the care team (wellness team, registered dietitian, social worker, community health workers).Act as the member’s advocate and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies.
• Ensure that all Care Management processes and reporting are compliant with all applicable federal and state regulations, and NCQA and company standards.
• Participate in delegation collaboration activities, as required.
• Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making care management recommendations.
• Enter and maintain documentation in the Electronic Medical Records System (EMR), meeting defined timeframes and performance standards.
• Maintain an understanding of Care Management principles, program objectives and design, implementation, management, monitoring, and reporting.
• Actively participate on assigned committees.
• Attend and complete all department-mandated training as well as satisfy educational in-service requirements.
• Perform other related projects and duties as assigned.
• Provide ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care.
• Develop, implement and coordinate plan of care and facilitate members’ goals.
• Coordinate interdisciplinary team tasks and activities, with the goal of maintaining team performance and high morale.

Qualifications

• Active and unrestricted RN license required in NY state
• CCM certification preferred
• 4-6+ years of clinical experience (Required)
• Organization/prioritization ability; and the ability to effectively manage a caseload of highly complex members (Required)
• Support an integrated care model tapping into appropriate resources both internally and external to the organization (Required)
• Experience in case management/care coordination, managed care, and/or utilization management (Preferred)
• Trained in the use of Motivational Interviewing techniques (Preferred)
• Experience working in medical facility or practice and/or with electronic medical records (Preferred)
• Computer proficiency: MS Office (Word, Excel, Powerpoint, Outlook); mobile technology (wireless phone/laptop, etc.) (Required)
• System user experience in a highly automated environment (Required)
• Bilingual ability (verbal, written) (Preferred)
• Strong cross-group collaboration, teamwork, problem solving, and decision‑making skills (Required)
• Ability to work a flexible schedule (evenings, weekends and holidays) to meet member and/or caregiver and departmental scheduling needs (Required)

• Hiring Range: $68,040-$118,800

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.