RN Case Manager: Care Coordination & Outcomes

Univera HealthСare; City of Rochester (NY); Hybrid; USD 62.000 - 118.000; Vollzeit

Zusammenfassung

Univera Healthcare is seeking a Case Manager to conduct comprehensive case management activities aligned with CMSA, NCQA, NYS DOH, CMS and FEP/NCQA standards. You will identify, educate, coach, and coordinate care, collaborating with providers to develop proactive, cost-effective care plans for members.

The role involves cross-functional teamwork, adherence to regulatory requirements, and ongoing education to improve health outcomes while maintaining member privacy and compliance with company

Qualifikationen

• Associates degree required; bachelor's degree preferred.
• Active NYS RN, Registered Dietitian, or Physical Therapist licensure required.
• Minimum of three years of clinical experience; case management experience preferred.
• Proficient with Microsoft Office Suite.
• Experience interpreting managed care benefit plans and government contracts (Medicare/Medicaid) preferred.
• Strong written and verbal communication skills.
• Ability to multitask and work independently.
• Case Management Certification preferred; required for FEP line within two years.

Aufgaben

• Lead physical health member clinical management programs.
• Maintain knowledge of CMSA, NCQA, DOH, CMS regulations and standards.
• Adhere to departmental, corporate, state and federal standards and licensure requirements.
• Implement the Case Management Process from identification to closure.
• Screen and refer members based on defined populations and criteria.
• Open cases timely and use motivational interviewing to gather essential information.
• Collaborate with physicians and providers to develop interdisciplinary care plans.
• Educate members/caregivers and connect them with community resources.
• Mentor junior staff and ensure adherence to performance metrics.
• Promote participation in other health plan programs and digital health tools.

Kenntnisse

Communication skills

Case management

Regulatory knowledge

Multitasking

Independent work

Ausbildung

Associates degree

Bachelor's degree preferred

Tools

Microsoft Office Suite

Jobbeschreibung

Univera Healthcare is seeking a Case Manager to conduct comprehensive case management activities aligned with CMSA, NCQA, NYS DOH, CMS and FEP/NCQA standards. You will identify, educate, coach, and coordinate care, collaborating with providers to develop proactive, cost-effective care plans for members.

The role involves cross-functional teamwork, adherence to regulatory requirements, and ongoing education to improve health outcomes while maintaining member privacy and compliance with company