Nurse Care Manager

Overview

Who You Are You are devoted, compassionate, and enjoy being on the front lines in healthcare, changing the lives of your patients. You are passionate about getting to the root cause of a patient’s conditions, removing social determinants of healthcare, and ensuring the highest possible quality of life for those in your care. You don’t want to sacrifice quality over quantity, and you aim to provide the same level of care and commitment to your patients that you would to your own family member. Does this sound like you? If so, we should talk. Who We Are We are a groundbreaking team of healthcare professionals focused on making a major impact in healthcare. We align every aspect of our health plans to support patients seeing our providers; we drive health improvements, create a seamless member experience, and eliminate duplicative costs. We listen to the needs of our patients and our employees, continually working to push beyond the status quo in which the care system manages patients today. For us, it’s all in a day’s work. Your Role You will collaborate with an assigned panel of Physicians, Advanced Practice Providers, and ancillary team members to manage the patient's specialized needs based on their individual condition. Your job duties will include taking full ownership of patients within your panel, with additional focus on patients with complex chronic conditions, serious illness, or advanced frailty. You will perform assessments to identify member needs based on their values, goals and preferences. From this assessment, you will develop comprehensive care management plans for each member. These care plans will be used to coordinate patient care delivery with Honest clinicians, network providers, contracted vendors, and community-based services. Primary functions of this role: Quickly builds empathetic relationships with patients and families, Evaluates and identifies patient’s needs based on their respective values, goals, and preferences, then translates these needs into clinical needs Interfaces with Primary Care Physicians, Advanced Practice Providers, Specialists, and various disciplines on the development of case management plans/programs. In conjunction with the Physician/APP, implements care/treatment plan by coordinating access to health services across multiple providers/ disciplines. Monitor care and identify cost-effective measures, including recommendations for alternative levels of care and utilization of resources. Effectively coordinates patient admissions and discharges from hospitals or skilled nursing facilities via coordination with respective facility clinicians and case managers. Build relationships across network hospitals, SNFs, home health companies, and DME vendors within the respective community. Monitors and evaluates the effectiveness of the case management plans based on quality and cost drivers and modifies as necessary. Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families. Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers' compensation carriers and third-party administrators. Prepares reports, communicates program changes to appropriate staff and develops protocols in accordance with compliance requirements. Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care. Develops individualized patient/family education plan focused on self-management, delivers patient/family education specific to a disease state. Develops and updates training and educational materials and presents to appropriate staff, members, and families. Facilitates patients' return to normal daily activities by teaching and making appropriate referrals for outside services/continued care. Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement. Engages internal resources to identify and respond to Social Determinants of Health such as lack of transportation, stable housing, or food resources. Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards. Participates in the formulation and implementation and monitoring of action strategies and outcomes of care or customer service. Ensures that accurate records are maintained of the care associated with each patient. Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies. Actively participates in huddles, IDT sessions, and patient case conferences. Commendably represents our company to patients, their families, and the community. Basic Qualifications: Current RN License is required, BSN preferred. 1+ years of utilization management experience preferred. 3+ years of clinical practice in a hospital, clinic, home care, or nursing home setting highly Case management experience and CCM preferred but not required. Disease management and/or physician office experience How You are Supported You will benefit from our company's exceptional total rewards package, including competitive base pay with bonuses, paid time off starting at 4 weeks for full time employees, 10 paid holidays per year, reimbursement for continuing medical education, 401k with match, health, dental, and vision insurance. Family friendly policies that support paid parental leave and flexible work arrangements. As a team member you’ll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career with us. You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of our high-quality, value-based, care model

Qualifications

• Bachelor's degree or higher
• Valid Registered Nurse (RN) in New York (NY)
• Utilization Management (1+ years)
• Clinical Practice (3+ years)
• Do you have disease management and/or physician office experience?

• Valid BSN in New York (NY)

Company

Our client is a Home Health Care Service company that partners with local Primary Care Doctors to continuously challenge the status quo in care provided for people with Medicare. They focus on the whole care experience. This means improved patient outcomes and it also saves money.