Nurse Care Manager - SHP - Healthfirst - United States

Our mission is to ensure that our members have superior healthcare and satisfaction; we significantly improve the health and wellness of the New York metropolitan area, while driving down the costs. Employees shape our company and connect us to our communities. We look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers:
Dream Big, Plan Wisely
Break Down the Walls
Think Critically, Speak Up, Deliver with Pride
Inspire Through Trust, Lead By Example
Be Unstoppable
The Nurse Care Manager at Senior Health Partners (SHP) a Managed Long-Term Care (MLTCP) reporting to the Clinical Manager ensures high quality community-based member care through appropriate allocation of member services and resources. Monitors and evaluates effectiveness of the care plan to ensure member/caregiver satisfaction with services. Acts as a resource to staff in the planning and delivery of outstanding member care.

Note: Occasional Overtime and "On-Call" required

Responsibilities:
Maintains ongoing telephonic communication with members and their caregivers to ensure a safe and appropriate care plan.
Member & family education re: health management and community resources.
Appropriately manages member care including but not limited to; coordination of benefits (Medicare & Medicaid), coordinating & monitoring all skilled services, durable medical equipment (DME) and community resources.
Maintains oversight and communication with members and providers during inpatient acute, sub-acute and/or long-term admissions.
Occasionally conducts home and nursing home visits to ensure continuity of care and appropriate care management. Completes documentation in (Private Health Information) PHI database (CCMS) of all member care. Intervenes to resolve any grievances and/or concerns re: member care and safety.
Maintains a current knowledge base of federal (Medicare) and state (Medicaid) regulations. Assists in the collection of data for quality improvement initiatives. Encouraged to participate in committees to support performance improvement.
Occasionally rotates "On-Call" / may require overtime to ensure 24/7 team response to member needs. (includes weekends and after hours). Maintain communication with the team and know when to escalate to clinical manager and/or senior management.
Identifies barriers and develops innovative solutions to ensure quality care.
Additional duties as assigned.
Qualifications:

Minimum Qualifications:
NYS Registered Nurse with minimum of Associate’s degree from an accredited program.
Work experience as a NY licensed RN working in a home care environment or as a staff nurse in an acute, sub-acute or long term care (LTC) setting or managed-long term care (MLTCP)
Ability to occasionally travel to a member's home for assessments.
Occasional overtime required.
Occasional "On-call" required.
Unexpired driver’s license or non-driver’s license ID (DMV Identification). After employment, State registration with the Uniform Assessment System (UAS) for long-term care in NY State is required to access for training, testing and system usage. Upon completion of UAS training the State will administer testing online. If a passing score is not achieved, the State will allow the individual to retake the test once. The UAS access is a necessity for this position, so employment is contingent on acceptance and continued authorization by the State to have UAS access
Telecommuter Requirements:
Ability to work remotely is dependent upon completion of training and passing audit scores, which varies by department. It is also contingent on the following telecommuter requirements:
Designated work area at the Telecommuting location away from the main flow of home traffic which meets OSHA and departmental policy.
Broadband solution will be a cable modem type using an Ethernet connection from a reputable provider such as Comcast, Cox Cable or Cablevision, TW or fiber service such as FIOS or AT&T Uverse offered by Verizon, AT&T or regional partners.
Usage of a DSL broadband is not recommended and will not be supported by Healthfirst’s Technical Services team, additionally; wireless is also not recommended with both options requiring prior approval of the division Vice President and Human Resources.
Separate designated work area away from the main flow of home traffic.
No dependent care.
Healthfirst has the right to a conduct home site inspection.
Random work activity audit reports will be conducted for all telecommuting employees analyzing performance and system activity on a given day.
The employee will be supplied with all necessary equipment and applications for business purposes only.
Preferred Qualifications:
Basic Microsoft Word, Excel, Outlook, electronic medical records database, efaxing and electronic archiving skills Must possess excellent judgment in order to resolve any grievances and/or concerns about patient care and safety. Requires very accurate typing skills and interact through electronic documentation using multiple electronic PHI databases and security requirement tools such as encryption. Excellent interpersonal skills, especially the ability to relate well with seniors, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations. Excellent written communication and the ability to document grammatically correct notes. Understanding of and sensitivity to cultural differences and needs of the community are essential. Must be adept at operating within a diverse and multi-cultural work environment and community of Members such as Spanish, Chinese, Russian, Creole and Korean. Experience managing member information in a shared network environment using paperless database modules and archival systems. Experience working in a team environment, exercising independent thinking and problem-solving. Ability to communicate on an individual basis as well as in a group setting. As a representative of SHP effective interpersonal skills must be demonstrated consistently while interacting with members/families/support staff for daily collaboration on care plans with Care Management Team (CMT). Ability to prioritize. Experience managing large case loads. Adept at working in an environment with fast-past changing priorities while achieving departmental goals and objectives. Thorough knowledge of current community health practices for the frail adult population and cognitively impaired seniors. Knowledge of care management including the concepts and philosophy and relevant standards of patient care. *LI-JV1
Healthfirst - 4 days ago - save job  Healthfirst is a not-for-profit managed care organization sponsored by some of the most prestigious and nationally recognized hospitals and...

View the original article here