Hybrid Registered Nurse Care Manager

at CareSource

• Job title: Registered Nurse Care Manager
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $100,000 - $160,000 per year
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, Bronx, United States

About the role

• Nurse Care Manager responsible for care coordination and member assessments. Ensuring quality health outcomes and facilitating covered plan services for optimal living conditions.

Responsibilities

• Responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services
• 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
• 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
• 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

Requirements

• 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

Benefits

• Comprehensive total rewards package
• Health insurance
• Professional development opportunities
• Bonuses tied to company and individual performance