Healthcare - Care Manager V - Buffalo, United States - APN Consulting

Description

Job Title:
Healthcare RN Care Manager V

Location:
Buffalo, NY (Field position)

Duration: 6 Months

Job Description:


TRUE/CORRECT Title:
UAS RNs


Position Summary:
Schedule will be M-F 8:30AM-5PM

Field position in Upstate NY Buffalo temps will visit members in their homes, assisted living facilities and nursing homes.

Daily responsibilities will be conducting UAS Assessments to support care management

Candidates will be assigned a minimum of 15 cases per week


Orientation:

Orientation will be 5 days for current UAS certified RNs


MUST be bilingual (Korean, Chinese, Mandarin, Spanish or Bengali) - PLEASE INDICATE ON RESUME WHICH LANGUAGES THE CANDIDATE SPEAKS


Required Experience:

Management will accept


ONLY:
UAS Certified RN licensed in the state of NY
New grads will be considered.
Candidates with no UAS will be considered if they have experience with home care management.


Required Education:

Bachelor's Degree or Health Education (a combination of experience and education will be considered in lieu of degree).


Required Licensure/Certification:

NY State RN License.


Essential Functions/Responsibilities:
Conduct face to face assessments of members' functional status, medical, behavioral, psychosocial and community resource needs.

Provides the Interdisciplinary Care Team (ICT) with assessment information and act as facilitator to ensure that members' needs are met.

Develop an ICP/PCSP based on members' clinical, behavioral and social needs that addresses barriers to care.
Competently assesses members' health status and ensures that member is receiving all necessary medical and supportive services
Modify ICP/PCSP as appropriate to member's needs and progress
Manage care transitions through effective and timely communication necessary for member care and discharge planning.
Clarifies SWH plan medical benefits, policies and procedures for members, providers and community-based agencies.
Prepare for and participate in clinical case reviews to share best practices.
Adhere to SWH documentation policies and procedures including documentation of clinical assessment activities and their effectiveness.
Maintain a comprehensive working knowledge of community resources, payer requirements, and network services for target population

Collaborate with other SWH Care Managers to reduce variations in clinical practice, identify opportunities for systems' improvement, and develop policies and procedures relevant to practice.

Provide backup to other Assessment nurses as needed
Analyze data and use it to improve care delivery
Performs other duties as assigned.


Skills/Aptitudes:
Strong professional level of knowledge and comprehensive clinical assessment skills in the adult population and chronic disease management
Excellent communication skills

Strong computer skills:
competent in Microsoft Office Products (Outlook, Word, Excel)
Ability to work independently and maintain flexibly in fast paced environment
Ability to analyze data and use it to improve care delivery
Self-starter with high level of accountability and responsibility for outcome of care
Highly organized and able to manage multiple priorities appropriately
Independent problem solving skills
Able to work collaboratively and build enduring relationships with providers, members and the multidisciplinary team


Summary:

Responsible for health care management and coordination of *** members in order to achieve optimal clinical, financial and quality of life outcomes
Works with members to create and implement an integrated collaborative plan of care
Coordinates and monitors Client members progress and services to ensure consistent cost effective care that complies with Client policy and all state and federal regulations and guidelines


Essential Functions:

Provides case management services to members with chronic or complex conditions including: o Proactively identifies members that may qualify for potential case management services
o Conducts assessment of member needs by collecting in-depth information from Clients information system, the member, members family/caregiver, hospital staff, physicians and other providers
o Identifies, assesses and manages members per established criteria
o Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs
o Performs ongoing monitoring of the plan of care to evaluate effectiveness
o Documents care plan progress in Clients information system
o Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes
o Measures the effectiveness of interventions to determine case management outcomes
Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Client members
Conducts face to face or home visits as required
Maintains department productivity and quality measures
Manages and completes assigned work plan objectives and projects in a timely manner
Demonstrates dependability and reliability
Maintains effective team member relations
Adheres to all documentation guidelines activities
Attends regular staff meetings
Participates in Interdisciplinary Care Team (ICT) meetings
Assists orientation and mentoring of new team members as appropriate
Maintains professional relationships with provider community and internal and external customers
Conducts self in a professional manner at all times
Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct
Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth
Complies with required workplace safety standards


Knowledge/Skills/Abilities:

Demonstrated ability to communicate, problem solve, and work effectively with people
Excellent organizational skill with the ability to manage multiple priorities
Work independently and handle multiple projects simultaneously
Strong analytical skills
Knowledge of applicable state, and federal regulations
Knowledge of ICD-9, CPT coding and HCPC
Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration
Familiarity with NCQA standards, state/federal regulations and measurement techniques
In depth knowledge of CCA and/or other Case Management tools
Ability to take initiative and see tasks to completion
Computer skills and experience with Microsoft Office Products
Excellent verbal and written communication skills
Ability to abide by Clients policies
Able to maintain regular attendance based upon agreed schedule
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers


Required Education:

Bachelors Degree in Social Work or Health Education (a combination of experience and education will be considered in lieu of degree)


Required Experience:

10+ years of clinical experience with Case Management experience


Required Licensure/Certification:

Must have valid drivers license with good driving record and be able to drive locally