Virtual 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 • 3-5 years of progressively responsible in a high-volume call health care or social service-related • Registered Nursing degree with an 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: • Remote office work; may be sitting for long periods of time. • Ability to work independently and maintain flexibility in a fast-paced start-up environment. • Must have access to reliable daily transportation in the event of a patient emergency. 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 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.