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    Healthcare - Care Manager III - New York, United States - APN Consulting, Inc

    APN Consulting, Inc
    APN Consulting, Inc New York, United States

    3 weeks ago

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    Description

    Job Title:
    Care Manager III

    Location:
    Remote

    Duration: 6 Months

    Job Description:

    Will the position be 100% remote? There are some circumstances that CM need to visit mbr at home or in facility
    But the chance is extremely low.


    • Are there any specific location requirements? No- They can sit anywhere in US as long as they are licensed in NY State but they will not be able to convert to perm if they are not in tri state area.
    • What are the must have requirements? Knowledge of MLTC and NY Medicaid policy
    Actually creating the care plans for adult/ geriatric patients
    Not just working with MLTC dept coordinator
    Also NOT in just a hospital or nursing home or facility.


    • What specific experience do they need to have/know? MLTC experience, Acknowledge of UAS Assessment.
    • What are the day to day responsibilities? Outreach calls and Person-Centered Care Plan reviews
    Coordinate care, manager caseload, create Patient Centered Service Plans.


    • Is there specific licensure is required in order to qualify for the role? RN/LMSW/LCSW- Licensed in the State of NY
    • What languages are required? Spanish
    • What sort of case load will this person manage? 2-3 PCSP review per day, or caseload
    For context the NY Health plan added 940 new members last month.

    Must have previous experience working remote
    Self-motivated, tech savvy and able to work indecently to complete a min of 7 successful calls a day,
    At the end of the month the CM must have 125 contacts with members.

    Will require- laptop, keyboard, mouse, headset, dual monitors and a docking station.


    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:
    5-7 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.
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