Nurse Care Manager
Job Closed
Overview
Required Skills and Experience: •2+ years’ experience in a member services department, health care organization, Community Based Organization, or social services environment •Demonstrated experience in a managed care or HMO setting is strongly preferred •Three (3) to Five (5) years of progressively responsible in a high-volume call health care or social service related •Registered Nursing degree with active license •Valid New York State driver’s license •In depth knowledge of managed care product portfolio, benefits, policies and procedures •Bilingual (Spanish) a plus What You Need to Know: •Office work; may be sitting for long periods of time. •Some travel may be required. •Ability to work independently and maintain flexibly in fast paced start up environment. •Must have access to reliable daily transportation. Additional Job Details: •be the team member primarily responsible for the most medically complex members •identify, develop, and implement the individual care plan (ICP) •orient new members to the MVP DSNP program and educate the member, family and/or primary caregiver regarding plan benefits •work directly with members, members’ families and/or advocates, providers, and community service organizations on an ongoing basis to address their needs and wishes •ensure that members have access to the range of supportive services needed to promote quality of life, including social and health support services •empower members to make informed decisions and advocate on their behalf •conduct in-home, work, or day program visits (if you are on a field-based team) •assist members in reducing/resolving challenges or barriers to achieve their optimal level of health, independence, safety, and well-being •meet with physician representatives to identify member health needs (virtual or in-person for field-based teams) •develop and maintain a collaborative relationship with community-based resources, and the entire Belong Health team •promote a culture of accountability and performance to both meet and exceed personal service vision goals and ensure timely and satisfactory resolution of highly complex, specialized, and non-routine customer issues
Company
Our client is a Hospital and Health Care company that partners with regional health plans and hospital systems to help deliver a more compassionate, straightforward insurance experience for Medicare-eligible individuals. They help deliver best-in-class Medicare Advantage (MA) and Specials Needs Plan (SNP) products, creating new opportunities for organic growth that enable better service for their existing membership.