Integrated Resources, Inc
Registered Nurse (RN) - Care Manager
Integrated Resources, Inc, New York, New York, United States, 10004
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.
Skills:
* Minimum of five (5) years of clinical experience as a Registered Nurse
* Leadership experience preferred
* Experience in: Care Coordination, Utilization Review, Discharge Planning
* Computer literacy required
* Bilingual Spanish Certification in Case Management
Education & Licensure :
* Licensed Registered Nurse (RN) in the State of New York (required)
* Baccalaureate degree (required)
* PRI and Screen certification required within three (3) months of employment
* Preferred Qualifications: Master's Degree
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.
Skills:
* Minimum of five (5) years of clinical experience as a Registered Nurse
* Leadership experience preferred
* Experience in: Care Coordination, Utilization Review, Discharge Planning
* Computer literacy required
* Bilingual Spanish Certification in Case Management
Education & Licensure :
* Licensed Registered Nurse (RN) in the State of New York (required)
* Baccalaureate degree (required)
* PRI and Screen certification required within three (3) months of employment
* Preferred Qualifications: Master's Degree