Case Manager responsible for member well-being and preventing hospital admissions. Conduct assessments, develop care plans, and coordinate healthcare services for patients.
Responsibilities
responsible for helping members achieve a level of well-being, to avoid preventative hospital admissions or readmissions through the administration of quality improvement functions
perform telephonic outreach to members, physicians, or other care givers to develop a plan of care for the member who needs CM services
perform case management functions using a member-centric, collaborative process to optimize the wellness and functional capability of members
adhere to regulatory and compliance requirements, adhere to department productivity and quality metrics
conduct comprehensive assessments of the member’s health and psychosocial needs
identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs
document the patient’s plan of care in a timely manner
Requirements
Registered Nurse (RN) with active, current, unrestricted NYS license
licensed master social worker (LMSW)
master’s in social work (MSW)
licensed dietician with case management experience required
Case Management Certification (CCM) required
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.
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