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Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential Accountabilities: Level I • Handles behavioral health member clinical management programs., • Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable., • Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,, • Maintains confidentiality and conducts information management procedures per corporate and departmental policy., • Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews., • Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services., • Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals., • Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena., • Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits., • Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment., • Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources., • Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist, • Accepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable., • Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications., • Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care., • May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA)., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Handles all member clinical condition management programs., • Offers process improvement suggestions and participates in the solutions of more complex issues/activities., • Mentors junior staff and assists with coaching whenever necessary., • Consistently meets/exceeds all productivity and performance metrics, including positive results of audits., • Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health., • Manages more complex assignments and/or larger caseloads., • Displays leadership skills and serves as a positive role model to others in the department., • Participates in the orientation of new staff. Level III (in addition to Level II Accountabilities): • Process Management and Documentation - o Identifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies. o Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions. o Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department. • Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems., • Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers., • Provides backup for the Supervisor/Manager, whenever necessary by: o Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care. o Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing. o Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. • Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Active NYS RN license required with three years' behavioral health experience; or LMSW; or LCSW; or LMHC., • Minimum of three years of clinical experience required. Case Management experience preferred., • Must demonstrate proficiency with the Microsoft Office Suite., • Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred., • Strong written and verbal communication skills., • Ability to multitask and balance priorities., • Must demonstrate ability to work independently on a daily basis., • Deliver efficient, effective, and seamless care to members., • For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB. Level II (in addition to Level I Qualifications) • A minimum of 2 years in case management position., • Case Management Certification preferred, • Delivers efficient, effective, and seamless care to members., • Demonstrates ability to escalate to management, as necessary., • Demonstrates proficiency in all related technology and documentation requirements., • Consistently meets or exceeds all performance metrics. Level III (in addition to Level II Qualifications) • Must have been in a current Case Management position or similar subject matter expert for at least 5 years., • Case Management Certification required, • Broad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems., • Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues., • Ability to lead the training of new staff., • Demonstrated presentation skills. Physical Requirements: • Ability to travel and work long hours on a computer., • May require flexible hours to meet needs of member discussions. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: E2: Minimum: $62,400 - Maximum: $ 96,081 Level II: E3: Minimum: $62,400 - Maximum: $ 106,929 Level III: E4: Minimum: $65,346 - Maximum: $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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Job Description The Oncology Nurse Navigator (ONN) is a registered nurse who serves as a key member of the oncology care team on a full time basis, guiding patients and their families through the complexities of a cancer diagnosis, treatment, and survivorship. The ONN provides individualized education, emotional support, and care coordination to promote timely access to diagnostic, treatment, and supportive services. This role functions as a patient advocate and liaison between patients, families, physicians, and the multidisciplinary care team to reduce barriers to care, improve communication, and enhance the overall patient experience. The Oncology Nurse Navigator promotes evidence-based care, facilitates shared decision-making, supports transitions across the continuum of care, and works to reduce disparities in cancer outcomes by ensuring patients receive appropriate resources and follow-up. Duties and Responsibilities (including but not limited to): • Collaborate with the multidisciplinary oncology team to facilitate timely coordination of services (appointments, tests and procedures) across the cancer continuum from pre-diagnosis through survivorship to allow for an optimal patient experience, • Provide education to the patient and their family/caregiver about cancer diagnosis, treatments, symptoms that should be reported to their physician, clinical trials, and support services, • Perform a comprehensive assessment of the patient and their family/caregiver’s needs that would interfere with their cancer treatment, • Connect the patient with the resources including but not limited to community agencies, national resources, and support services they need during treatment, • Complete Social Determinants of Health (SDoH) assessment to understand patients’ life context and barriers to care and connect patients to internal and external resources based on their individual needs, • Explain cancer care issues to the patient and their family in their primary language or in easy-to-understand language, • Utilizes Interpreter Services for patient communication, • Review culturally appropriate support groups and educational programs that address local cultural issues and beliefs related to cancer for the patient and their family/caregiver, • Provide continuity of support while moving from one aspect (diagnosis) of the cancer experience to others (treatment, survivorship, end-of-life), • Participates in Quality team meetings, site meetings, Commission on Cancer (CoC) meetings – when appropriate, and meetings for grant process development and improvement initiatives, • Identifies system and/or organizational barriers to care, and recommends strategies to address them, • Participate in the development of navigation assessment tools, guidelines, pathways and algorithms across the continuum of care, • Coordinate regularly scheduled multidisciplinary cancer conferences including preparation, participation and case presentation and documentation/communication of recommendations for assigned disease sites, • Participate in the completion of cancer focused community needs assessment and review on an annual basis, • Complete mandatory educational lessons as outlined by Human Resources and GLIN, IPA management, • Maintain confidentiality of patients, families, caregivers and staff, • Participate in Patient Advisory Committee and/or Patient and Family Centered Care Committee, • Completes Oncology Screening Nurse Navigation competency trainings and professional development opportunities, including required number of oncology navigation related continuing education hours annually (may vary based on AONN/Oncology Nursing Society (ONS)/CoC requirements), • Other duties as assigned Qualifications: • Associate’s degree in Nursing Degree from a program accredited by Commission of Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN) or Commission for Nursing Education Accreditation (CNEA) required, • Bachelor of Science – BSN preferred, • Work Experience, • Minimum two years oncology, including solid tumor nursing experience required, • Experience working in a high volume, fast-paced setting required, • Oncology ambulatory nursing care coordination experience preferred, • Prior experience with telephone triage in oncology, • Licenses and Certifications, • Registered Nurse license required, • Valid driver’s license, • OCN or AONN certification (ONN-CG) preferred, • Obtains Academy of Oncology Nurse & Patient Navigators’ (AONN) Oncology Patient Navigator Certification within (2) years of hire., • Completes Oncology Screening Nurse Navigation competency trainings and professional development opportunities, including required number of oncology navigation related continuing education hours annually (may vary based on AONN/Oncology Nursing Society (ONS)/CoC requirements) Knowledge, Skills and Abilities: • Problem-Solving, • Technical Skills, • Patient/Customer Service, • Interpersonal Skills, • Oral Communication, • Team Work, • Written Communication, • Delegation, • Leadership, • Quality Management, • Visionary Leadership, • Business Acumen, • Cost Consciousness Ethics • Organizational support, • Adaptability, • Dependability, • Initiative, • Judgment, • Self-Motivated, • Serves the following age groups, • Adult patient and family members (18-65 years), • Geriatric patient and family members (over 65 years) This is a hybrid position with onsite presence at oncology practice locations in Western New York (some traveling required) along with potential for remote work. We offer an outstanding benefits package including health, dental, 401K, vacation, and PTO, as well as a great working environment Pay range $75,000 to $85,000 The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within job’s compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, expertise of the individual, and internal equity considerations. Equal Employment Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and leads New York in provider and patient satisfaction. Great Lakes Integrated Network (GLIN) values diversity, inclusion, and equity as matters of fairness and effectiveness. We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feels welcomed and engaged. Great Lakes Integrated Network is an Equal Opportunity Employer

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Master's Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role. Minute Clinic has also been awarded the American Nurses Credentialing Center (ANCC) Pathway to Excellence premier designa

Practice of registered professional nursing by a nurse practitioner may include the diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures within a specialty of practice, in collaboration with a licensed physician qualified to collaborate in the speci

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Job Posting: Nurse Practitioner Wanted for Growing Pain Management Office in Buffalo. Position: Nurse Practitioner Location: Buffalo, NY Schedule: One day a week (with potential for increased hours) Start Date: Immediately. We are a rapidly growing pain management office in Buffalo seeking a dedicat

Master's Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role. Minute Clinic has also been awarded the American Nurses Credentialing Center (ANCC) Pathway to Excellence premier designa

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The RN (Registered Nurse) Case Manager provides case management and nursing services to Hudson Valley Hospice patients and their families and to ensure that those services are consistent with the philosophy, goals, objectives and policies of the Agency. Register Nurse (RN) Case Managers work in vari

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The overall purpose of the Wellness Nurse position is to provide Person-Centered Care consistent with accepted standards and expectations of Sunshine Retirement Living and state regulations. The Wellness Nurse's responsibilities include, but are not limited to, monitoring resident health status, pro

Current NYS registration as a Registered Professional Nurse, Nurse Practitioner and American Heart Association-Basic Life Support (BLS) required upon hire and must be maintained thereafter. For Registered Nurse clinical positions, internal applicants must have been employed in the same job title as

Sign-On Bonus: _Due to rapid growth, we need dynamic Nurse Practitioners or Physician Assistant's to join our team of Physicians, Nurses and Social Workers. Board Certification Obtain a minimum of 35 CMEs per year CPR certification Valid NYS Drivers License and active automobile insurance to

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