RN Case Manager
Summary
| Title: | RN Case Manager |
|---|---|
| ID: | CM06 |
| Location: | Rochester |
| Job Type: | Full-time |
| Date Posted: | 07/19/2018 |
| Openings: | 1 |
| Department: | Case & Disease Management |
Description
Are you looking for an amazing opportunity that allows you to work directly in our community and with an amazing organization? At YourCare Health Plan, we focus exclusively on the safety-net population and we've been doing so for more than 45 years. We provide compassionate, high-touch care for individuals on government sponsored healthcare programs and provide support for the community-based partners who help them.
This position requires a current RN licensure as you will be providing case management services to our members with high risk or complex medical, behavioral health and/or psychosocial problems. If you have a strong history of working on and communicating between multi-disciplinary teams, have a strong analytical background (working within spreadsheets and evaluating utilization trends), you have the ability to navigate through data systems (RHIO, HealtheLink, PSYCKES) and you possess strong skills related to Patient Center Communication, Trauma Informed Care and Motivational Interviewing, this could be the position for you!
GRADE: 307
POSITION SUMMARY
POSITION HAS DIRECT REPORTS No
ESSENTIAL JOB DUTIES/FUNCTIONS
OTHER FUNCTIONS AND RESPONSIBILITIES
- Identifies opportunities to improve processes and services. Shares with Manger and Clinical Services Leadership issues that are obstacles to providing great service.
- Performs other duties as assigned.
MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS
- Experience in insurance industry. Managed Medicaid experience a plus.
- Experience in Case Management delivery.
This position requires a current RN licensure as you will be providing case management services to our members with high risk or complex medical, behavioral health and/or psychosocial problems. If you have a strong history of working on and communicating between multi-disciplinary teams, have a strong analytical background (working within spreadsheets and evaluating utilization trends), you have the ability to navigate through data systems (RHIO, HealtheLink, PSYCKES) and you possess strong skills related to Patient Center Communication, Trauma Informed Care and Motivational Interviewing, this could be the position for you!
GRADE: 307
POSITION SUMMARY
Provide case management to members with high risk or complex medical, behavioral health and/or psychosocial problems through community and home based visits and telephonic support. Provide linkage to appropriate community resources, referral to appropriate care services, and communicate with providers in order to reduce health disparities and improve health care outcomes.
Provide oversight of outreach staff related to provision of support to members on a case by case basis. Develop and implement targeted initiatives based on member preference and disease states that promote improved health care outcomes and quality of life.
POSITION HAS DIRECT REPORTS No
ESSENTIAL JOB DUTIES/FUNCTIONS
|
% of Time
|
Essential Function |
70%
|
Provides Case Management Services. Under the direction of the Manager or Clinical Coordinator, the Case Manager will: - Provide case management to members with high risk or complex medical and psychosocial problems through community and home based visits and telephonic support. - Provides linkage to appropriate community resources, referral to appropriate care services, and communicate with providers in order to reduce health disparities and improve health care outcomes. - Acts as an advocate for members to assure access and service delivery across the continuum of care and community resources. - Develops and implements targeted initiatives based on knowledge and expertise in clinical practice and disease states that promote improved health care outcomes and quality of life. - Meet regulatory and agency policy and procedures related to the practice and documentation of case management activities. - Demonstrate strong interpersonal skills in order to handle difficult situations in a professional and courteous manner. - Handles confidential information in accordance with HIPPA , state and federal confidentiality rules. |
20%
|
Communication - Interacts, as appropriate, with other internal and external agency staff. Attends team meetings, trainings, and other functions, as assigned by manager. - Presents and expresses information in an organized, understandable and complete manner. - Able to positively influence others. |
| 10%
|
Reporting and Back Up - On a monthly basis, review charts for regulatory compliance and address errors/omissions - Assist manager in the collection and reporting of metrics for reporting to internal/external entities. |
OTHER FUNCTIONS AND RESPONSIBILITIES
- Identifies opportunities to improve processes and services. Shares with Manger and Clinical Services Leadership issues that are obstacles to providing great service.
- Performs other duties as assigned.
- Current NYS RN license.
- Bachelor’s Degree or a minimum of 5 years equivalent training/education/experience in Nursing or other health related area.
- Effective and diplomatic oral communication skills. Good listening skills.
- Sound reasoning and problem solving skills.
- Strong computer skills.
- Ability to read, understand and follow written policies and procedures.
- Ability to learn new skills.
- Ability to interact with individuals with diverse cultural and religious customs.
- Must have a NYS driver’s license and car for community travel.
PREFERRED QUALIFICATIONS
- Bachelor’s Degree or a minimum of 5 years equivalent training/education/experience in Nursing or other health related area.
- Effective and diplomatic oral communication skills. Good listening skills.
- Sound reasoning and problem solving skills.
- Strong computer skills.
- Ability to read, understand and follow written policies and procedures.
- Ability to learn new skills.
- Ability to interact with individuals with diverse cultural and religious customs.
- Must have a NYS driver’s license and car for community travel.
- Experience in insurance industry. Managed Medicaid experience a plus.
- Experience in Case Management delivery.
This opening is closed and is no longer accepting applications
