Offres rn case manager remote à Albany, New YorkCréer des alertes d'emploi

Job Description: Summary: The Case Manager H2H (RN) is responsible and accountable for coordinating the care of CDPHP members who meet criteria for services across the continuum of care. Activities focus on the successful transition of care for CDPHP members who have been hospitalized and are being discharged, with a focus on readmission avoidance. Specific activities include member outreach, medication review, identifying barriers to care, care planning and collaboration with providers. Case Managers will also provide education and support to members who have ongoing chronic health needs, they will also serve as a resource to answer day-to-day clinical questions from members and other CDPHP business areas. The Case Manager H2H will navigate a variety of applications and platforms in the daily administration of work. They must combine strong clinical knowledge and critical thinking to coordinate and support a care plan that will monitor quality medical care for the member population serviced by CDPHP. This is a telephonic role. Essential Accountabilities: • Provide a well-coordinated care experience for patient/families, including, effectively monitoring length of stay, readmissions and coordinating the activities of multiple disciplines utilizing nursing judgment., • Collaborate with members/families, providers, medical staff, utilization review staff, embedded case managers and/or others to coordinate a safe transition from the hospital setting., • Perform detailed medication reviews, identify discrepancies and communicate with providers to resolve discrepancies. Support member to ensure they are taking medications as prescribed., • Build relationships with hospitals and provider offices to allow for collaborative information exchange and prompt appointment setting requests., • Advocate for members to obtain the most appropriate health care services in collaboration with members of the health care team., • Facilitate communication among different disciplines to assist in the coordination of care. If embedded, meet with CDPHP members at designated facilities to assist them with their anticipated discharge needs., • Develop care plans that include mutual and realistic goals, interventions, and expected outcomes., • Revise and adjust the care plan to fit the needs of the member based on continuing assessment, medication changes or member's condition., • Effectively utilizes community resources and community support systems to reduce avoidable readmissions, • Identify and address social determinants of health (SDOH) and facilitate referrals to Social Work Case Management, Behavioral Health and/or psychosocial community support systems or resources., • Identifies variations in care delivery and notifies manager and/or supervisor of any patterns or trends., • Engage, communicate with and coach patients telephonically and/or face-to-face. Educate members (family/caregivers) regarding their disease process and self-management strategies. Evaluate understanding of disease processes to prevent further complications., • Educate members, families and health care providers regarding benefits, availability of services, community resources, alternative funding, and health care alternatives., • Identify and facilitate access to social service agencies, community organizations, patient support groups, and other adjunct services to minimize and prevent inappropriate hospital stays and maintain maximum achievable health status., • Maintain comprehensive computerized records of all care management activities., • Participate in team and office meetings as needed., • Maintain departmental standards for all duties as outlined by CDPHP policies and procedures., • Precept new employees to the department., • Volunteer at health fairs, workshops and other corporate events and present in-services when appropriate., • The employee agrees to comply with CDPHP's Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Resources or the Chief Executive Officer., • Perform other duties as assigned. Minimum Qualifications: • Associates degree or two (2) years of equivalent experience required., • Registered Nurse with a current New York State license is required., • Bachelor's degree in Nursing preferred., • Certified Case Manager (CCM) certification preferred., • PRI (Patient Review Instrument) certification preferred., • Minimum three (3) years clinical experience is required., • Experience with chronic condition management required, experience with diabetes and heart disease is preferred., • Case management experience preferred., • Experience working with health, social service and funding resources, including community agencies and alternate care delivery systems is preferred., • Experience in home care, medical office setting, hospital or managed health plan preferred., • Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint are required., • Demonstrated ability to provide case management for complicated members with multiple comorbidities and chronic diseases., • Demonstrated ability to work collaboratively on a team., • Demonstrated ability to communicate effectively with members with varying levels of education, health literacy and understanding., • Demonstrated ability to work with diverse population., • Ability to navigate system applications with accuracy., • Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions., • Demonstrated ability to interact with providers, members to positively impact the quality of patient care., • Demonstrated ability to manage multiple projects in conjunction with a frequently changing patient caseload., • Demonstrated ability to work with and maintain confidential information., • Demonstrated ability to provide excellent customer service and develop relationships both internally and externally., • Excellent verbal and written communication skills., • Flexibility to adapt to a changing and fast-paced environment., • Ability to travel to a variety of sites across CDPHP service area, during regular business hours, evenings and possibly weekends may be required., • Valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile required., • Annual Physical assessment, as well as any other clinical requirements, will be required by the designated facility., • Spanish speaking preferred. 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): E2: Minimum: $62,400 - Maximum: $ 96,081 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.

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 physical 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., • May participate in the orientation of new staff., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Essential 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 Essential Accountabilities) • Process Management and Documentation, • Identifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies., • Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions., • 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:, • Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care., • Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing., • 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 • Associates degree required. Bachelor's degree preferred., • Active NYS RN or Registered Dietician or Physical Therapist licensure required., • 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.

This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs.The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to ident

Employee Vesting at 5 year work anniversary 403B Retirement plan thru Lincoln Financial Medical, Dental and Vision coverage start 60 days after start date Medical Coverage thru CIGNA Dental Coverage thru choice of Cigna PPO plan or AETNA DMO plan Vision coverage thru United Healthcare FREE Online RN

Hybrid/Remote options once trained. Certification in Case Management (CCM) preferred.

Employee Vesting at 5 year work anniversary 403B Retirement plan thru Lincoln Financial Medical, Dental and Vision coverage start 60 days after start date Medical Coverage thru CIGNA Dental Coverage thru choice of Cigna PPO plan or AETNA DMO plan Vision coverage thru United Healthcare FREE Online RN

Employee Vesting at 5 year work anniversary 403B Retirement plan thru Lincoln Financial Medical, Dental and Vision coverage start 60 days after start date Medical Coverage thru CIGNA Dental Coverage thru choice of Cigna PPO plan or AETNA DMO plan Vision coverage thru United Healthcare FREE Online RN

The RN will authorize covered services and coordinate care regardless of payer The Nurse Care Manager will collaborate and communicate with member/family/caregivers, primary care practitioners, and the interdisciplinary team The RN MUST have proficiency in any of the following languages to be consid

Hybrid/Remote options once trained. Certification in Case Management (CCM) preferred.

Are you a bilingual RN Case Manager looking to work within MLTC? Call me TODAY: 949-277-5432 Why join us? Top NYC Health Plan Highly competitive base pay Great benefits including HRA/FSA 403B with match Collaborative culture with friendly team Relocation assistance available Unlimited Growth Opportu

Employee Vesting at 5 year work anniversary 403B Retirement plan thru Lincoln Financial Medical, Dental and Vision coverage start 60 days after start date Medical Coverage thru CIGNA Dental Coverage thru choice of Cigna PPO plan or AETNA DMO plan Vision coverage thru United Healthcare FREE Online RN

Employee Vesting at 5 year work anniversary 403B Retirement plan thru Lincoln Financial Medical, Dental and Vision coverage start 60 days after start date Medical Coverage thru CIGNA Dental Coverage thru choice of Cigna PPO plan or AETNA DMO plan Vision coverage thru United Healthcare FREE Online RN

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 withi

Peter's Health Partners in Albany is seeking an RN Case Manager for a full-time, day shift position. Candidates need a valid NYS RN license, a Bachelor of Science in nursing, and ideally 2 years of acute care experience.

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We now offer Daily Pay through a trusted third-party provider, giving you faster access to your earnings. Current State RN license required.

Employee Vesting at 5 year work anniversary 403B Retirement plan thru Lincoln Financial Medical, Dental and Vision coverage start 60 days after start date Medical Coverage thru CIGNA Dental Coverage thru choice of Cigna PPO plan or AETNA DMO plan Vision coverage thru United Healthcare FREE Online RN

Current New York State RN license required.

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The Travel Registered Nurse (RN) provides high-quality patient care across a variety of healthcare settings and specialties. RNs assess patient conditions, administer treatments, monitor progress, and collaborate with multidisciplinary teams to ensure the best possible outcomes for patients. Active

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidates to tr

Current New York State RN license required.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to workfor you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignmentanywhere in this great country.We want the same like-minded, awesome candidates to trav

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RN Loan Forgiveness Program to aide in paying off your RN student loan debt. Is personally responsible for obtaining, and maintaining, a current RN license within the hiring state and/or compact licensure in which nursing duties are performed and must meet all state board of nursing requirements.

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