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RN Care Manager
2 months ago
About the Role:
Care Solutions, a Managed Care Organization, is seeking a skilled RN Care Manager to join our multidisciplinary team. As a RN Care Manager, you will play a vital role in identifying and managing members who require additional care or support in their home to improve their quality of life.
Key Responsibilities:
- Provide case management through telephonic assessments, care planning, implementation, care coordination, monitoring, and evaluation to ensure members receive services and supports required to meet psychosocial, educational, and healthcare needs.
- Develop, facilitate, and communicate a plan of care in partnership with the member, their significant other, primary caregiver, primary and attending physicians, and various other providers involved in the member's care.
- Initiate utilization review for preauthorization and post-service reviews.
- Utilize knowledge of community resources and the member's benefit structure.
- Interact with providers and facilities in a professional, respectful manner.
- Recognize quality of care issues and escalate them appropriately.
- Assist members with the coordination of services from various settings as appropriate.
- Comply with all CCS standards for documentation.
- Participate in case rounds.
- Participate in on-call coverage.
- Participate in other meetings as requested.
- Participate in quality improvement initiatives.
Requirements:
- Active and unrestricted NYS RN license.
- Strong written and verbal communication skills.
Preferred Qualifications:
- Bachelor of Science in Nursing.
- CCM certification.
- Knowledge of Milliman or InterQual criteria.
- Experience providing care in the home setting.
- Experience working within a managed care environment.
About Care Solutions:
Care Solutions is committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by law.
