Position Overview The primary goal of the Care Manager is to optimize members' health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the members' needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member's needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members' care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.
Scope of Role & Responsibilities - Provide care management support during transitions of care.
- Complete transitions of care assessment to identify member needs.
- Complete medication reconciliation.
- Address members' clinical, psychosocial, financial, environmental, and social determinants of health needs.
- Provide services to members of varying age, risk level, clinical scenario, culture, financial
means, social support, and motivation
- Engage members in a collaborative relationship, empowering them to self-manage their
physical, psychosocial, and environmental health to improve and maintain lifelong well being
- Prepare member-oriented plans of care with members, caregivers, and health care providers,
integrating concepts of cultural sensitivity and privacy practices
- Participate in interdisciplinary rounds
- Ensure plans of care include individualized goals and interventions
- Communicate plans of care to primary care physicians and other members of the care team.
- Address gaps in care with the members and providers
- Address members social determinants of health issues
- Link members to appropriate community and organizational resources.
- Provide care management support during Transitions of Care
- Ensure member and caregiver understanding by addressing language barriers, stress reactions, cognitive limitations, and other obstacles to care.
- Educate members and caregivers on chronic disease management, preventive care, medication adherence, medication reconciliation, home safety, and other relevant health topics.
- Provide complex/comprehensive care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
- Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options.
- Employ critical thinking and sound judgment when addressing unplanned issues and complex situations.
- Maintain knowledge of chronic conditions and utilize job aids and clinical resources as appropriate.
- Maintain accurate, comprehensive, and current clinical and non-clinical documentation in the Care Management Systems
- Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
- Maintain professional competencies as a Care Manager
- Other duties as assigned by Leadership
Required Education, Training & Professional Experience - Bachelor's Degree required.
- Minimum 2 years of care management experience in a healthcare setting or in a managed care organization.
- Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required.
- Ability to work closely with members and caregivers.
- Ability to work collaboratively with various team members, interdepartmentally, and leadership.
Licensure and/or Certification Required Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED).
Professional Competencies - Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
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