Manager at PwC leading Duck Creek Policy and Claims projects. Responsible for system implementations and team management with focus on mentoring and strategic planning.
About the role
- Nurse Care Manager providing care coordination including assessments and planning for members' health needs in New York. Engaging interdisciplinary teams to ensure quality outcomes and member advocacy.
Responsibilities
- The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.
- 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.
- Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs.
- Identifies same day grievances, investigates and documents accordingly.
- Documents care management/coordination according to company policy.
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
- Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
- Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
- Strong advocate for members at all levels of care
- Bilingual speaking and writing skills are preferred.
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
- Bonuses tied to company and individual performance
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