Senior Nurse Case Manager

POSITION SUMMARY

We are seeking a dedicated Nurse Case Manager to manage a Case Management Team to provide transitions of care and complex case management for our patient population. This is a unique role where the candidate works in collaboration and continuous partnership with chronically ill and/or “high-risk” patients and their family/caregivers(s), clinic/hospital/specialty providers and staff, and community resources in a team-based approach to:

• Promote timely access to appropriate care
• Reduce emergency room utilization and hospital readmission
• Increase comprehension through culturally and linguistically appropriate education
• Create and promote adherence to a care plan, developed in coordination with the patient, their PCP, and family/caregiver(s).
• Increase continuity of care by managing relationships with tertiary care providers, transitions-of-care, and referrals.
• Facilitate and address care and quality gaps.
• Address SDoH by facilitating, coordinating, and connecting patients to relevant community resources, with the goal of enhancing patient health and well-being, increasing patient satisfaction, and reducing healthcare costs.
• Supervise a team of case managers and collaborate with social workers to provide optimal service and patient outcome.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• The Senior Nurse Case Manager would ensure contract, regulatory and NCQA compliance for the delivery of integrated care management, care coordination, and utilization management
• Manage and oversee the daily activities of the case managers in:
• Provide ongoing support to the staff by promoting ongoing training and education to the staff.
• Timely completion of administrative tasks such as but not limited to patient engagement and assessment, documentation of clinical and nonclinical findings and request medical records such as discharge summaries from healthcare facilities for patients and/or providers
• Coordinate and facilitate post hospital care transition between patient/caregivers with their PCP.
• Formulate a problems, interventions and goals and develop a care plan in conjunction with the PCP and/or patient’s family/caregivers to address the patient’s personal health care and SDoH needs.
• Conduct medication reconciliation as indicated.
• Monitor patient regularly according to protocol and evaluate for changes that may require health interventions.
• Consult with patients and family members to address their health, behavioral and social needs.
• Educate patients about their condition, provide relevant community resources, and give them specific instructions.

• Assistant management in ensuring the development of policies and procedures to meet NCQA Case Management Standards
• Attend ongoing training and courses to keep abreast of new developments in health care.
• Comply with organizational guidelines, and maintain contractual requirements with Federal, State, Local and Payor sources.
• Ensures clinical integration across providers, and other community-based programs.
• Drives Program performance through ongoing oversight of care management practice and as informed by analysis of key performance indicators
• Oversee relationships between CAIPA ‘s case management and community-based PCPs and Specialists.
• Works with Clinical Director, Director of Quality, Medical and Behavioral Health Medical Directors, and Chief Medical Officer to achieve the population health management goals for CAIPA membership including appropriate utilization of healthcare services and quality of care

MINIMUM QUALIFICATIONS

• Currently licensed as a Registered Nurse in the State of New York
• Must have at least 3 years of case management experience in a managed care and delegated care management settings
• Bilingual Mandarin and/or Cantonese speaking is a preferred
• Excellent oral and written communication skills and ability to foster a supportive environment internally and externally.
• Compassion and empathy
• Excellent organizational skills, including time-management
• Strong interpersonal and teamwork skills
• Familiarity with risk management and quality assurance control
• Demonstrate a clear understanding of standard clinical procedures, laws and regulations
• Must be able to demonstrate basic skills using Microsoft Word, Excel, and PowerPoint.