Associates degree in Nursing required; Bachelor's preferred
Minimum of 3 years experience as a registered nurse
Preferred clinical experience in geriatrics or managed long-term care
Bilingual skills may be required based on operational needs
Current, unrestricted Registered Nurse license in New York required
Responsibilities
Ensure care continuity by assessing and monitoring member needs
Authorize services and coordinate care across payers
Collaborate with members and interdisciplinary teams
Facilitate independent living arrangements for members
Conduct home visits to assess living situations and member needs
Support discharge planning for safe transitions from services
Document care management activities according to policy
Benefits
Potential for performance-based bonuses
Substantial comprehensive benefits package
Flexible working hours, including evenings and weekends as needed
Mobile position requiring travel to various locations
Opportunities for professional development and training
Full Job Description
Job Summary:
The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.
Essential Functions:
Ensures consistent care along the entire health care continuum by assessing and closely monitoring members' needs and status.
Authorizes covered services and coordinates care regardless of payer.
Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
Works with member/family to maintain the most independent living situation possible
Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
Regularly assesses members for ongoing eligibility for services based on the specific plan's eligibility criteria.
Performs home visits as required to assess members' living situation, cultural influences, functional and cognitive needs.
Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
Ensures appropriate, safe plan for members' discharge from their plan.
Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.
Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
Responds to members' requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated
Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.
Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.
Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members' needs.
Perform any other job related duties as requested.
Education and Experience:
Associates degree in Nursing from an accredited nursing program required
Bachelor's degree in Nursing preferred
Three (3) years of experience as a registered nurse required
Clinical experience in geriatrics and/or managed long-term care experience preferred
Experience using multiple languages may be required based on operational needs
Competencies, Knowledge and Skills:
Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
Ability to communicate effectively with a diverse group of individuals
Ability to multi-task and work independently within a team environment
Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
Adhere to code of ethics that aligns with professional practice
Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
Strong advocate for members at all levels of care
Strong understanding and sensitivity of all cultures and demographic diversity
Ability to interpret and implement current research findings
Awareness of community & state support resources
Critical listening and thinking skills
Decision making and problem-solving skills
Strong organizational and time management skills
Bilingual speaking and writing skills are preferred
Licensure and Certification:
Current, unrestricted Registered Nurse licensure in the state of New York required
Case Management Certification preferred
Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
Working Conditions:
This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
Over 50% (Mobile) Routine travel required
Compensation Range:
$100,000 - $135,000
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary): Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.
About Caresource
CareSource is a nonprofit health plan that provides managed care services to individuals and families in Ohio, Kentucky, Indiana, and West Virginia. The company was founded in 1989 and is headquartered in Dayton, Ohio. CareSource offers a variety of health insurance plans, including Medicaid, Medicare Advantage, and Marketplace plans. The company is committed to improving the health and well-being of its members and invests in programs and services that promote healthy living. CareSource is one of the largest Medicaid managed care plans in the United States.
