Care Manager
4 days ago
Care Manager Job Summary
Care Management is a collaborative process that includes assessing physical, social, and environmental factors that affect the lives of Prime Care Coordination members. The Care Manager implements an appropriate quality and cost-effective plan that utilizes all resources available to meet those needs.
The Care Manager utilizes evidence-based health strategies to prevent hospitalization and inappropriate utilization of emergency room visits. The process is cyclical in several phases: assessing, stratifying, planning, implementing/coordinating care, and reassessing/evaluating.
Responsibilities:
- Oversee caseload of managed care members
- Review and evaluate the member's assessment and UAS information
- Develop comprehensive service plans
- Make referrals to appropriate health and community resources in a timely manner
- Review and authorize requests for services according to workflows and timeframes
- Maintain clear, effective communication with members continually, including monthly calls
- Educate members and caregivers on covered services and benefits
- Evaluate members in their residences on an as-needed basis
- Promote healthy living and injury prevention for members
- Evaluate available clinical data and notes, including assessments
- Evaluate members' responses to interventions and make modifications as necessary
- Collaborate with interdisciplinary teams
- Document all interventions
- Maintain members' privacy, confidentiality, health, and safety
- Adhere to ethical, legal, accreditation, certification, and regulatory standards and guidelines
- Demonstrate cultural competence by being respectful of and responsive to the health beliefs, practices, cultural, and language needs of members and their support systems
- Participate in Quality Assurance and Improvement activities
- Be on call
- Perform all other duties assigned by supervisors
Essential Academic and Experience Requirements:
- New York State Licensed Registered Nurse, Bachelor's degree preferred, or Licensed Master's Social Worker
- Minimum five years in a healthcare-related field, with two years as a Care Manager in a managed care environment or community health
- Must be at least 18 years old
- Reliable transportation (NYS Driver's License required)
- Ability to work independently and motivate others
- Ability to communicate effectively, both orally and in writing
- Maintain all required certifications/training by State regulations and Prime Care Coordination policy
- Bilingual a plus
- High attention to detail
- Experience utilizing computer software, including Microsoft Word and clinical applications
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