Nurse Case Manager, RN (Case Management) (Garden City, NY)

• Responsible for telephonic case management, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Develop a plan of care and course of action to address all issues and barriers
• Provide care coordination for patients including chronic disease management/education and interdisciplinary collaboration while complying with policy and procedures and contractual and regulatory requirements
• Develop and implement case management plans in collaboration with member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.
• Establish appropriate timeframe and frequency for follow-up, case closure, or referral for services as the member transitions through the continuum
• Performs on-going monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changed accordingly
• Follow evidence based guidelines and contact standards to facilitate closure of gaps in care and encourage use of in network services.
• Applies clinical judgment to identify precipitating cause of admission to prevent hospital readmissions
• Oversees all transition of care events to ensure continuity of care
• Delegates and oversees Priority Care Coordinator activity
• Consistent application and/or interpretation of evidence based criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs
• Assess for barriers to care, provides care coordination and assistance to member to address concerns
• Presents cases at interdisciplinary rounds to obtain a multidisciplinary perspective and recommendations to achieve optimal outcomes
• Demonstrated accountability and skills in analysis, problem solving, decision making, time management, and oral and written communications
• Facilitates interdisciplinary care team meetings and informal ICT collaboration
• Displays professionalism through good work habits as observed in all encounters
• Uses motivational interviewing to educate, support, and motivate change during member contact
• Keeps current with all standards, policies and procedures of HealthCare Partners and acts as a resource to other staff members with necessary
• Reviews completed HRAs and Medication Reconciliations to determine need and preliminary stratification level for case management
• Other related duties as required

• Versed in use and application of MCG Guidelines
• Knowledge of NCQA, Federal, State and other Regulatory requirements
• Excellent verbal and written communication skills, expressing self in a clear, concise, and professional manner
• Ability to work collaboratively and effectively with the interdisciplinary team members, patients, families, and external case managers
• Skilled in managing competing priorities and deadlines while demonstrating the ability to effectively prioritize and manage multiple tasks
• Excellent time management and organizational skills

• NYS RN license required
• BSN preferred

Department: Medical Management
This is a non-management position
This is a full time position