Careers Integrated Resources Inc
Registered Nurse(RN) - Care Manager
Careers Integrated Resources Inc, New York, New York, United States
Job Title: Registered Nurse (RN) - Care Manager
Job Location: New York, NY 10004
Job Duration: 2- 3 Months (Possibility of extension)
Shift time: 8 AM TO 4 PM/ 9 AM to 5 PM
Pay - $60/hr. - $65/hr. on w2
Note: We have openings for Manhattan/ Brooklyn/ Bronx/ Queens (choose any location, shift, department as per experience)
Position Overview: Role & Responsibilities: · Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business. · Develop a working relationship with the PCP to be able to contact and discuss the care of the member with them. · Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team. · Identify the risk factors and assign the risk category to the member. · As part of Care Management team, develops a formal care plan for all services needed for the member, including the member’s disaster plan. · Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary. · Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions. · Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care. · Prior approve request for additional services based on assessments and using evidence-based standards refer denial, reduction, or limitation of service request to Medical Director. · Assist members with the coordination of services both within and outside networks as appropriate. Includes facilitating discharge from acute setting and alternate settings. · Provides Care Coordination through continuum of care. · Optimizes both the quality of care and the quality of life for the members. · Coordinate with Utilization Management (UM) department on concurrent and retrospective review. · Follow up with assigned nurses for clinical updates to care plan. · Document within two business day’s coordination notes and routine contacts with the members · according to the level of risk assigned to them. · Participate in team care planning meetings. · Handles complains that can be resolved in one day · Assists Customer Service and the UM department by providing records and materials needed for · grievances from MLTC/MAP program members · Speaks to members who are delinquent in their spend-down payments. · Cooperates with all department within · Identifies members appropriate for specialty programs. · Performs all MLTC/MAP management activities in compliance with all regulatory agency requirements. · Provides information on all requests from Quality Management Department to be reviewed by the various Quality committees. · Completes all other tasks assigned by MLTC Department Leadership. · Participates in the department on call schedule/being on call, which is rotated amongst the care team.
Shift time: 8 AM TO 4 PM/ 9 AM to 5 PM
Pay - $60/hr. - $65/hr. on w2
Note: We have openings for Manhattan/ Brooklyn/ Bronx/ Queens (choose any location, shift, department as per experience)
Position Overview: Role & Responsibilities: · Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business. · Develop a working relationship with the PCP to be able to contact and discuss the care of the member with them. · Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team. · Identify the risk factors and assign the risk category to the member. · As part of Care Management team, develops a formal care plan for all services needed for the member, including the member’s disaster plan. · Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary. · Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions. · Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care. · Prior approve request for additional services based on assessments and using evidence-based standards refer denial, reduction, or limitation of service request to Medical Director. · Assist members with the coordination of services both within and outside networks as appropriate. Includes facilitating discharge from acute setting and alternate settings. · Provides Care Coordination through continuum of care. · Optimizes both the quality of care and the quality of life for the members. · Coordinate with Utilization Management (UM) department on concurrent and retrospective review. · Follow up with assigned nurses for clinical updates to care plan. · Document within two business day’s coordination notes and routine contacts with the members · according to the level of risk assigned to them. · Participate in team care planning meetings. · Handles complains that can be resolved in one day · Assists Customer Service and the UM department by providing records and materials needed for · grievances from MLTC/MAP program members · Speaks to members who are delinquent in their spend-down payments. · Cooperates with all department within · Identifies members appropriate for specialty programs. · Performs all MLTC/MAP management activities in compliance with all regulatory agency requirements. · Provides information on all requests from Quality Management Department to be reviewed by the various Quality committees. · Completes all other tasks assigned by MLTC Department Leadership. · Participates in the department on call schedule/being on call, which is rotated amongst the care team.