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Professional Case Manager

2 months ago

Schenectady, New York, United States MVP Health Care Full time
Job Summary

This position will utilize the essentials of an integrated Case Management model that includes assessment, planning, implementation, care coordination, monitoring and advocacy to meet the member's comprehensive health needs.

Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner to provide appropriate education, resources, and healthcare coaching.

The principal role of the position is to engage individual members and communicate with an established interdisciplinary team to create an individualized person-centered care plan.

In addition, the position will provide guidance in understanding benefit coverage and navigating the health care delivery system, including but not limited to Medicaid and Medicare benefits.

The overall objective is to create solutions to overcome barriers to care and assist members to achieve optimum health and/or improved functional capability through the coordination of quality, cost effective care.

The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. Other duties as assigned by supervisor.

Key Responsibilities
  • Utilize integrated Case Management model to meet member's comprehensive health needs
  • Identify medical and psycho-social needs of designated members
  • Provide education, resources, and healthcare coaching
  • Engage individual members and communicate with interdisciplinary team
  • Provide guidance on benefit coverage and health care delivery system
  • Monitor and review cases with Medical Director
Requirements
  • Current New York State Licensure as a Registered Nurse
  • Possession of Vermont licensure is preferred but can be obtained post-hire
  • RN with multiple state licenses is preferred
  • Bachelor's degree in nursing preferred
  • Case Management Certification preferred (ANCC or CCM)
  • At least 3 years of recent clinical and Case Management experience
  • Experience with Medicaid and Medicare programs and benefits strongly preferred
  • Certification in Case Management required within 24 months after hire
Preferred Qualifications
  • Excellent oral and written communication skills
  • Demonstrated clinical knowledge including an understanding of population health management and the Case Management process
  • Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines
  • Ability to work in an energetic team environment
  • Experience with situations requiring strict adherence to confidentiality
  • Ability to solve problems while exhibiting clinical judgment and realistic understanding of the current environment
  • Ability to make independent decisions regarding care coordination, and quality of care
  • Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or the care plan
  • Ability to demonstrate strong judgment when dealing with emotionally charged situations
  • Strong computer skills including working knowledge of Windows and internet-based applications