Care Manager, RN or SW

US-NY-New York
Requisition ID
2017-15587
Department Name
Care Management

Overview

Company Overview:   Healthfirst is a not-for-profit managed care organization sponsored by some of the most prestigious and nationally recognized hospitals and medical centers in New York. We are one of the fastest growing health plans in our area with over 900,000 diverse members and a network of more than 24,000 providers and 3,400 employees.   Our mission is to ensure that our members have superior healthcare and satisfaction; we significantly improve the health and wellness of the New York metropolitan area, all while driving down the costs. Employees shape our company and connect us to our communities. We look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers:

- Dream Big, Plan Wisely

- Break Down the Walls

- Think Critically, Speak Up, Deliver with Pride

- Inspire Through Trust, Lead By Example

- Be Unstoppable

 

Position Summary:

The Care Manager plans and manages behavioral and/or physical care with members and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care and medical attention and addresses identified member needs across the continuum of care. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of the member’s health care services.

Responsibilities

Duties/Responsibilities:

  • Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
  • Conducts assessments to identify barriers and opportunities for intervention.
  • Develops care plans that align with the physician’s treatment plans and recommends interventions that align with proposed goals.
  • Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
  • Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly.
  • Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes.
  • Assists in identifying opportunities for alternative care options based on member needs and assessments.
  • Evaluates service authorizations to ensure alignment and execution of the member’s care and physician treatment plan.
  • Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
  • Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. 
  • Occasional overtime as necessary.
  • Additional duties as assigned.

Qualifications

Minimum Qualifications:

  • Diploma, Associate's, or Bachelor's nursing degree with NY State RN License and related behavioral health clinical/case management experience;
  • Master’s degree in a prepared mental health profession (Social Worker, Mental Health Counselor, Marriage and Family Therapist) with state license (e.g. LCSW, LMSW, LMFT, LMHC, LPC, LPA) and related clinical/case management experience;
  • Required to make nursing home, and other related sites visits around downstate New York.


Preferred Qualifications:

  • Fluency in Spanish, Korean, Mandarin, or Cantonese.
  • Knowledge of Interqual and/or LOCADTR.
  • Knowledge and experience with current community health practices for the frail adult population and cognitive impaired seniors.
  • Experience managing member information in a shared network environment using paperless database modules and archival systems.
  • Experience and knowledge of the relevant product line. 
  • Relevant work experience preferably as a Care Manager.
  • Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment.
  • Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems.
  • Experience using Microsoft Excel with the ability to edit, search, sort, filter, and other Microsoft and PHI systems.
  • Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.

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