RN Care Manager
$92,000–$92,000 year
On-siteBuffalo, New York, United States
Job Summary
Assess members' home health and level of care needs to coordinate medical, social, educational, and financial services within a member-centric service plan. Partner with social workers to facilitate the MLTC care model, develop person-centered service plans based on individual strengths and goals, and manage ongoing revisions as conditions change. Conduct utilization reviews to determine criteria for covered services, provide prior authorizations, and address financial or legal issues through appropriate referrals. Ensure documentation in the EMR meets professional standards while participating in disease management, utilization management, and quality improvement activities. Use standard assessment tools like UAS-NY and PRI to identify incipient problems and initiate early interventions for chronic care exacerbations.
Required Qualifications
- A current New York State Registered Nurse License
- A valid NYS Driver's license
- 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
- 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
- Computer skills, including working knowledge of Electronic Medical Records (EMR), Microsoft Office Suite (365)
- Must have a safe driving record
- Must be in good standing with the Medicare and Medicaid programs
- Possess good speaking and listening skills
- Must be free of communicable disease
- Must be able to read, write, speak, and understand the English language at an intermediate or more advanced level
Desired Qualifications
- BSN, AAS Degree or diploma in Nursing and Case Management Certification
- Previous UAS-NY
- Bilingual skills
- Use of standard patient assessment instruments such as PRI, UAS-NY
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