Case Manager

About the role

The Case Manager (CM) will be responsible for helping members achieve a level of well-being, to avoid preventative hospital admissions or readmissions through the administration of quality improvement functions. The CM will perform telephonic outreach to members, physicians, or other care givers to develop a plan of care for the member who needs CM services. The CM will perform case management functions using a member-centric, collaborative process to optimize the wellness and functional capability of members, using available resources to promote quality cost-effective outcomes. The Case Manager will apply the guiding principles for case management practice to include assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet a member's comprehensive health needs. The CM will adhere to regulatory and compliance requirements, adhere to department productivity and quality metrics, and provide exceptional customer service to all internal and external customers.

Requirements

• Registered Nurse (RN) with active, current, unrestricted NYS license, licensed master social worker (LMSW), master's in social work (MSW), or licensed dietician with case management experience required.
• Case Management Certification (CCM) required. Candidates without CCM certification are required to obtain it within two (2) years of commencing employment.
• Two (2) years of case management or clinical experience in acute medical/surgical/critical care or ambulatory setting required.
• Proficient computer and Windows skills required, including MS Office.
• Previous clinical experience in a managed care setting as a case/care manager preferred.
• Clinical knowledge of the health and social needs of the population served.
• Ability to identify barriers to a successful case management path.
• Excellent critical thinking and time management skills.
• Excellent written, verbal, and interpersonal communication skills with ability to provide exceptional customer service to external and internal customers to include telephonic interviewing of members; motivational interviewing skills a plus.
• Transferable knowledge, skill, and ability to complete job duties independently and proficiently.
• Flexibility in work schedules and assignments required.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
• Essential Accountabilities
• If selected by the Plan and approved by the NYSDOH, effectively serve as the Plan Foster Care Liaison who shall be responsible for clinical management and care coordination with OCFS, LDSS, and the VFCAs for all shared Medicaid children in foster care.
• Facilitate communication and coordination between members of the healthcare team; facilitate safe transition of care along the healthcare continuum.
• Identify cases that would benefit from alternative care through assessment and evaluation of the patient's needs, as well as available resources.
• Apply appropriate medical policies to evaluate the medical necessity, appropriateness and efficient use of healthcare services, procedures, and facilities across the continuum of care.
• Identify and review high-risk cases to ensure members are transitioned to the appropriate care.
• Document the patient's plan of care in a timely manner.
• Employ evidence-based guidelines and other self-management resources to maximize the member's health, wellness, safety, adaptation, and self-care.
• Understand case management concepts such as roles, philosophies, principles, liability, and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the

Benefits

Additional Information

FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

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Company Intel

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