Nurse Care Manager, Intake
LANGUAGE REQUIREMENT: Spanish OR Mandarin and Cantonese OR Korean
MUST BE WILLING TO TRAVEL TO Bronx OR Manhattan OR Brooklyn OR Queens
I. Position Summary:
The Nurse Care Manager for Intake works in collaboration with the prospect, enrollment and sales to conduct clinical assessments, recommend appropriate level of services and create an individual care plans. The development, Individual Care Plans based on a member's goals, preferences and disease states. The goal of the individual care plan is to link members to appropriate care, services, and community resources, promote self management in order to improve the health status, functioning, community integration and quality of life for SWH members in their preferred place of residence.
II. Essential Functions/Responsibilities:
- Conduct face to face and telephonic assessments of members' functional status, medical, behavioral, psychosocial and community resource needs.
- Develop an ICP/PCSP based on members' clinical, behavioral and social needs that incorporates barriers to care.
- Coordinate and arrange for all services required by a member in accordance with the ICP.
- Modify ICP/PCSP as appropriate to member's needs and progress
- Educates prospect on SWH plan medical benefits, policies and procedures for members, providers and community based agencies.
- Adhere to SWH documentation policies and procedures including documentation of Care Management 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 opportunity for systems' improvement, and develop policies and procedures relevant to practice.
- Provide backup to other Nurse Care Managers who conduct reassessments as needed
- Performs other duties as assigned.
Assessments scheduled for prospect or current members as scheduled by in-house Intake/Enrollment Coordinators
Level of care provided will have an impact on SWH's reputation in the community and membership growth.
Must be able to travel within their assigned location by either private or public transportation.
Knowledge of Medicare and Medicaid programs an advantage
Knowledge of chronic disease management
NYS assessment tool preferred
Minimum of 2 years of experience with home care, care management, recent acute care experience, or physician office experience.
Medicare/Medicaid managed care experience preferred
Experience in performing clinical assessment preferred
Experience working with a geriatric population or equivalent experience preferred
- Strong professional level of knowledge and comprehensive community resource skills in the adult population.
- Outstanding communication skills sufficient to related product benefits and create comprehensive clinical notes
- Strong computer skills: competent in Microsoft Office Products (Outlook, Word, excel)
- Ability to work independently, meet deadlines on paperwork and assignments and maintain flexibly in fast paced start up 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 with clinical, sales, internal intake, and customer services.
Minimum of 90% travel within service area
Must be available to cover other service areas as needed.
Level of Supervision:
Since enrolling its first member in Massachusetts in 2004, Senior Whole Health (SWH) has led the way as an affordable and innovative health care plan for "dual-eligible" people who qualify for both Medicare and Medicaid. Senior Whole Health is both an approved Medicare Special Needs Plan (SNP) and a Medicare Part D Plan. Available in Massachusetts and New York, Senior Whole Health provides members with better experiences through personal care management and comprehensive benefits.
Senior Whole Health's vision is to be a national leader in integrated health care that is simple, comprehensive, humane and respectful of its members.
Senior Whole Health's mission is to maximize our members' quality of life, health, security and independence by offering a voluntary health care plan that's simple to join, provides security and peace of mind through support and advocacy, and helps members live as independently as possible through comprehensive, community-based support and services.
New York, NY
Sat, 7 Oct 2017 12:24:01 PDT