Nurse Care Manager

» Nurse Care Manager
Healthcare
in New York City
, NY
Reference: 19-04357

Description:

The Nurse Care Manager plans and manages behavioral and/or physical care with members and their beneficiaries and works with clinicians and healthcare team members.  The Nurse Care Manager facilitates care and medical attention and addresses identified member needs across the continuum of care.  The Nurse Care Manager is responsible applying care management principles when engaging members and addressing coordination of members healthcare services.  The Nurse Care Manager is assigned to a specific product line such as FIDA, CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc.

Responsibilities:

  • Advocate, inform, and educate beneficiaries on services, self-management techniques, and health benefits
  • Conduct assessments to identify barriers and opportunities for intervention
  • Develop care plans that align with the physicians treatment plans and recommend interventions that align with proposed goals
  • Generate referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement
  • Collaborate with provider doctors, social workers, discharge planners, and community-based service providers to coordinate care accordingly
  • Coordinate and facilitate with the multi-disciplinary healthcare team as necessary in order to ensure care plan goals are achieved and maximize member outcomes
  • Assist in identifying opportunities for alternative care options based on member needs and assessments
  • Evaluate service authorizations to ensure alignment and execution of the members care and physician treatment plan
  • Contribute to corporate goals through ongoing execution of member care plans and member goal achievement
  • Document all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follow up as needed; and update care plans based on member needs, as appropriate