Care Manager RN

Care Manager RN

Job Ref: 121578
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT PROGRAM
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $108,815.00
Salary Range: $108,815.00 - $108,815.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.

Job Description

Address member's problems and needs: clinical, psychosocial, financial, environmental.

Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation.

Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health to improve and maintain lifelong well being.

Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices.

Participate in interdisciplinary rounds.

Ensure plans of care have individualized goals and interventions.

Communicate plan of care to Primary Care Physician.

Address gaps in care with the member and provider.

Address members social determinants of health issues.

Link members to available resources.

Provide care management support during Transitions of Care.

Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers.

Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.

Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports.

Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options.

Employ critical thinking and judgment when dealing with unplanned issues.

Maintain knowledge of Chronic Conditions and use job aids as a guidance.

Maintain accurate, comprehensive, and current clinical and non-clinical documentation in DCMS, the Care Management System.

Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process.

Maintain professional competencies as a Care Manager.

Other duties as assigned by Manager.

Minimum Qualifications

Bachelor's degree required (BSN)

Minimum 2 years’ prior experience in a health care setting, Care Management, or Managed Care setting required

Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required.

Ability to work closely with member and caregiver.

Registered Nurse with current NYS license.

Professional Competencies

Integrity and Trust

Customer Focus

Proficiency with computers navigating in multiple systems and web- based applications.

Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive.

Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities.

Time management and organizational skills.

Strong problem-solving skills

Ability to prioritize and manage changing priorities under pressure.

Ability to form effective working relationships with a wide range of individuals.

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