RN Care Manager

Overview Why join Elderwood IPA? Voted Buffalo Business First Best Places to Work 2020 & 2021! Monday-Friday Schedule w/ no weekends or overnights Remote working options Medical, Dental & Vision upon 1st of month following 60 days of hire Up to 140 hours (19 days) of PTO time PLUS six (6) holidays within the 1st year 401(k) retirement plan with vested employer match up to 4% Substantial Referral program Clean & Safe, State-of-the-Art Downtown Building Free Parking & convenient parking Join Our Team Join our strong and growing company today! Responsibilities In the role of an RN Care Manager, you are a critical resource for our members as you are responsible for assessing a member’s home health and level of care needs, assisting them in accessing necessary covered services, providing referrals and coordinating other medical services in support of their member centric service plan. The RN Care Manager also assists our members with obtaining needed medical, social, educational, psychosocial, financial, and other services, irrespective of whether the needed services are covered Elderwood Health Plan. You will partner with the Social Worker to facilitate the MLTC care model by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life. The RN Care Manager partners with the Social Worker to facilitate the MLTC care model by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life. Other critical competencies or tasks of this role include, but are not limited to: Provide a care management process of assessment, planning, facilitation, and advocacy for options and services to meet a member’s home health needs through collaboration, communication, and available resources, while promoting quality cost-effective outcomes. Perform comprehensive (physical, emotional, psychosocial, and environmental) assessments in the Member’s home to assess potential enrollees’ appropriateness for Managed Long-Term Care (MLTC), or to reassess a member’s status and needs. Developing and maintaining of a person-centered service plan based on a needs’ assessment identifying the strengths, capacities, preferences and long-term goals of the Member, resources available to meet member needs and ongoing revisions to the service plan based on the changes in the Member’s condition and status Participating in the utilization review process and evaluating to determine if the member’s condition and needs meet criteria for covered services and provide service prior authorization or denials to health care providers Review financial, legal, or medical issues and refer Members to social work or other professionals for estate planning, living wills, family trust, crisis services, and other programs Ensure that documentation in the care management record meets all applicable professional standards, using an EMR for each observation, verbal report, or interaction with the Member, Member’s caregiver/family, PCP or other provider, whether by home visit, telephonic, or written interaction Early identification of incipient problems or significant changes in Member conditions to initiate early intervention and strategies to prevent or more quickly treat chronic care exacerbations Participate in Disease Management, Utilization Management, and Quality Improvement activities. Competently use the UAS-NY assessment tool. Previous UAS-NY is desired, but not required. Training is available. Use of standard patient assessment instruments such as PRI, UAS-NY Qualifications BSN, AAS Degree or diploma in Nursing and Case Management Certification is preferred At minimum, a current New York State Registered Nurse License and a valid NYS Driver’s license Must have current knowledge of comprehensive case management, chronic care and geriatric issues, and best practices. Minimum of three (3) years nursing experience in home care, case management, discharge planning or managed care Minimum of one (1) year experience working with a frail or elderly population Minimum one year experience with health assessments Demonstrated favorable interpersonal and assessment skills. Ability to identify patterns, connections and underlying themes that lead to understanding and resolving complex problems or situations. Ability to focus on specific disease processes/health issues and identify strategies to promote client focused care planning Familiarity with provisions of governmental and accrediting agency health plan requirements. Familiar with applying clinical criteria when determining medical necessity and/or benefit administration. HIPPA Privacy Must possess computer skills, including working knowledge of Electronic Medical Records (EMR), Microsoft Office Suite (365) Ability to meet established productivity goals. Additional Requirements Must have a safe driving record and dependable car, as well as willingness to travel throughout the EHP service area & perform day travel w/in assigned geographic areas. A DMV motor vehicle report will be reviewed. Must be in good standing with the Medicare and Medicaid programs. This includes a criminal background check. Possess good speaking and listening skills. Bilingual skills are preferred, but not required. Must be free of communicable disease Additional Performance Requirements May be exposed to unsanitary conditions in some home settings. May be exposed to high crime areas within the service community. Endure exposure to weather and temperature extremes when visiting Member homes. This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level. EOE Statement WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. In the role of an RN Care Manager, you are a critical resource for our members as you are responsible for assessing a member's home health and level of care needs, assisting them in accessing necessary covered services, providing referrals and coordinating other medical services in support of their member centric service plan. The RN Care Manager also assists our members with obtaining needed medical, social, educational, psychosocial, financial, and other services, irrespective of whether the needed services are covered Elderwood Health Plan. You will partner with the Social Worker to facilitate the MLTC care model by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life. The RN Care Manager partners with the Social Worker to facilitate the MLTC care model by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life. Other critical competencies or tasks of this role include, but are not limited to: Provide a care management process of assessment, planning, facilitation, and advocacy for options and services to meet a member's home health needs through collaboration, communication, and available resources, while promoting quality cost-effective outcomes. Perform comprehensive (physical, emotional, psychosocial, and environmental) assessments in the Member's home to assess potential enrollees' appropriateness for Managed Long-Term Care (MLTC), or to reassess a member's status and needs. Developing and maintaining of a person-centered service plan based on a needs' assessment identifying the strengths, capacities, preferences and long-term goals of the Member, resources available to meet member needs and ongoing revisions to the service plan based on the changes in the Member's condition and status Participating in the utilization review process and evaluating to determine if the member's condition and needs meet criteria for covered services and provide service prior authorization or denials to health care providers Review financial, legal, or medical issues and refer Members to social work or other professionals for estate planning, living wills, family trust, crisis services, and other programs Ensure that documentation in the care management record meets all applicable professional standards, using an EMR for each observation, verbal report, or interaction with the Member, Member's caregiver/family, PCP or other provider, whether by home visit, telephonic, or written interaction Early identification of incipient problems or significant changes in Member conditions to initiate early intervention and strategies to prevent or more quickly treat chronic care exacerbations Participate in Disease Management, Utilization Management, and Quality Improvement activities. Competently use the UAS-NY assessment tool. Previous UAS-NY is desired, but not required. Training is available. Use of standard patient assessment instruments such as PRI, UAS-NY BSN, AAS Degree or diploma in Nursing and Case Management Certification is preferred At minimum, a current New York State Registered Nurse License and a valid NYS Driver's license Must have current knowledge of comprehensive case management, chronic care and geriatric issues, and best practices. Minimum of three (3) years nursing experience in home care, case management, discharge planning or managed care Minimum of one (1) year experience working with a frail or elderly population Minimum one year experience with health assessments Demonstrated favorable interpersonal and assessment skills. Ability to identify patterns, connections and underlying themes that lead to understanding and resolving complex problems or situations. Ability to focus on specific disease processes/health issues and identify strategies to promote client focused care planning Familiarity with provisions of governmental and accrediting agency health plan requirements. Familiar with applying clinical criteria when determining medical necessity and/or benefit administration. HIPPA Privacy Must possess computer skills, including working knowledge of Electronic Medical Records (EMR), Microsoft Office Suite (365) Ability to meet established productivity goals. Additional Requirements Must have a safe driving record and dependable car, as well as willingness to travel throughout the EHP service area & perform day travel w/in assigned geographic areas. A DMV motor vehicle report will be reviewed. Must be in good standing with the Medicare and Medicaid programs. This includes a criminal background check. Possess good speaking and listening skills. Bilingual skills are preferred, but not required. Must be free of communicable disease Additional Performance Requirements May be exposed to unsanitary conditions in some home settings. May be exposed to high crime areas within the service community. Endure exposure to weather and temperature extremes when visiting Member homes. This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.