Hybrid Care Manager, RN – Restricted Recipient Program

Posted 2 months ago

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About the role

  • Care Manager at Healthfirst coordinating physical and behavioral health care for diverse members. Engaging with clients, developing care plans, and collaborating with healthcare teams to improve outcomes.

Responsibilities

  • Plans, manages, and coordinates physical and behavioral care
  • Supports a variety of areas including the Recipient Restriction Program (RRP)
  • Conducts medical reviews of member usage patterns
  • Participates in RRP Committee meetings
  • Advocates and educates beneficiaries on services and self-management techniques
  • Develops care plans that align with the physician’s treatment plans
  • Generates referrals to providers and community-based resources
  • Coordinates care with the multi-disciplinary health care team
  • Evaluates service authorizations and updates care plans

Requirements

  • NYS RN
  • Strong interpersonal and assessment skills
  • Ability to relate well with seniors and their families
  • Fluency in Spanish, Korean, Mandarin, or Cantonese
  • Knowledge and experience with current community health practices for frail adults
  • Knowledge of InterQual and LOCADTR
  • Experience managing member information in a shared network environment
  • Demonstrated ability to manage large caseloads
  • Proficient with Microsoft Excel

Benefits

  • medical, dental and vision coverage
  • incentive and recognition programs
  • life insurance
  • 401k contributions

Job title

Care Manager, RN – Restricted Recipient Program

Job type

Experience level

Mid levelSenior

Salary

$81,099 - $117,466 per year

Degree requirement

Professional Certificate

Location requirements

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