Overview
Provides telephonic clinical care management services using evidence-based practices to ensure effective utilization of benefits, services, and care is provided to the patients allowing them to remain safely in their home/community.
Compensation:
$49.55 - $61.96 Hourly
What You Will Do
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Coordinates and/or oversees the coordination of benefits and services for all members on his/her caseload.
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Completes care management and disease specific assessments.
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Makes timely telephonic care management calls based on risk level.
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Resolves and coordinates complex issues and member complaints impacting the delivery of services.
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Provides health education to member/caregiver.
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Assess SDoH and provide care coordination to reduce/remove barriers of care to include ability to allow for changing levels of care based on assessments, trigger events and program data/reports.
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Identifies member safety issues and intervenes as necessary or refers to appropriate resources, such as community linkages, dietary, therapy (PT/OT/ST), HHA services, behavioral health, and DME.
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Coordinates the delivery of high quality, cost-effective care based on a customized population model of care supported by evidence based clinical practice guidelines.
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Advocates for the member/caregiver to obtain the health care and other services needed to optimize their quality of life.
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Utilizes the Care Management process to set priorities, plan, organize and implement interventions that are goal directed towards self-care outcomes and the transition to independent status.
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Promotes adherence to the physician treatment plan by providing education, coaching and support.
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Educates, coordinates, and provides resources to reduce inappropriate utilization of emergency room (ER) and hospital service.
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Increases utilization of primary care, specialty care, preventive health and guideline-based treatments including proper pharmacotherapy within network, as appropriate.
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Participates in interdisciplinary team (IDT) meetings and provide input on customer service-related activities.
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Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
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Ensures compliance with payors’ policies and procedures as well as all Federal and State regulations.
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Interprets and implements VNS Health policies, state and federal regulations.
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Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
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License and current registration to practice as a Registered Professional Nurse in NYS required or
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New York State License and current registration in Physical Therapy required or
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New York State License and current registration in Occupational Therapy required
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Certified Case Manager - Commission for Case Manager Certification within 1 year of employment required
Education:
- Associate's Degree in nursing required or Bachelor's Degree in Physical Therapy from a program approved by the New York State Department of Education required
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Bachelor's Degree in nursing preferred
Work Experience:
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Minimum two years of experience in health related field required
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Care management and/or managed care experience preferred
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Proficiency in Microsoft Office applications required
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Demonstrated analytical skills required