Clinical Case Manager, Care Management

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Review all clinical documentation completed by Registered Nurse Field Supervisors (RNFS) for comprehensiveness, accuracy, proper formatting, legibility, and compliance with standards of care.
• Maintain collaborative relationships with personnel from other provider organizations to coordinate patient services, develop joint educational initiatives, and ensure compliance with contractual clinical management obligations.
• Develop, implement, and maintain clinical policies and procedures in collaboration with team members while ensuring adherence to accreditation and regulatory standards.
• Participate in the development and maintenance of clinical evaluation tools used for RNFS screening, orientation, and field performance assessments.
• Contribute to the planning and development of business strategies focused on expanding nursing service opportunities.
• Assist in developing marketing strategies and actively participate in marketing initiatives to support business growth.
• Provide on-call coverage based on departmental needs.
• Counsel and advise individuals inquiring about services regarding appropriate levels of care and referral pathways for members and caregivers.
• Serve as a clinical resource and subject matter expert for staff across the organization.
• Ensure the delivery of high-quality patient care within the assigned area by supporting schedulers and RNFS in completing timely field visits for supervision, assessment, training, support, and crisis management.
• Anticipate and prevent patient incidents by addressing potential care or service-related issues communicated by Clinical Case Managers (CCMs), supervisors, HHAs, RNFS, patients, and caregivers.
• Participate in the investigation of incidents and complaints within the assigned area and collaborate with leadership on disciplinary actions when necessary.
• Support department leadership in onboarding and educating new staff members. Conduct field supervision and performance oversight for RNFS during their initial three months in a new role and annually thereafter.
• Monitor email communications to identify changes in patients' clinical conditions that may require escalation or modifications to the aide plan of care.
• Evaluate the effectiveness and efficiency of care and services provided, initiating case management conferences with healthcare team members as appropriate.
• Ensure all services are delivered in accordance with accepted nursing practices, regulatory requirements, and accrediting body standards.
• Participate in Quality Assurance and Performance Improvement (QAPI) activities as assigned.
• Assist with special projects and perform additional duties as assigned.

Licenses and Certifications:
License and current registration to practice as a Registered Professional Nurse, in New York State required

CPR Certification required

Master's Degree in Nursing preferred

Minimum of two years managerial experience in a LHCSA or CHHA preferred

Proficiency in Microsoft Office applications required

Excellent problem-solving and organizational, interpersonal, and verbal and written communication skills required