Registered Nurse Care Manager

🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $100k - $135k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Provide care coordination, including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services • Assess and closely monitor members' needs and status across the health care continuum • Authorize covered services and coordinate care regardless of payer • Collaborate with members, families, caregivers, primary care practitioners and the interdisciplinary team • Support members and families in maintaining the most independent living situation possible • Manage continuous care across hospital, sub-acute, long-term and home settings • Assess ongoing eligibility for services based on plan-specific criteria • Perform home visits to assess living situations, cultural influences, and functional and cognitive needs • Collaborate with the primary care physician and Inter-Disciplinary Team to develop Patient Centered Service Plans • Ensure safe and appropriate member discharge plans • Identify, investigate and document same-day grievances • Present complex care management cases at Intensive Care Management meetings • Respond to member requests within designated timeframes and complete Initial Adverse Determinations as indicated • Identify members requiring Care Management Review and formulate appropriate plans of care • Document care management and coordination according to company and plan policies • Develop efficient plans of care, authorize needed services at appropriate levels, utilize network providers and ensure services meet members' needs • Perform other related duties as requested

🎯 Requirements

• Associate degree in Nursing from an accredited nursing program required • Two (2) years of experience as a registered nurse required • Current, unrestricted Registered Nurse licensure in the state of New York required • Must have valid driver's license, vehicle and verifiable insurance • Successful clearance of a driver's license record check required • Annual Influenza vaccination required for designated positions during Influenza season • Intermediate proficiency with Microsoft Office, including Outlook, Word and Excel • Knowledge of local, state and federal healthcare laws and regulations and company case management policies • Knowledge of Case Management Society of America (CMSA) standards for case management practice • Ability to interpret and implement current research findings • Awareness of community and state support resources • Critical listening and thinking, decision-making and problem-solving skills • Strong organizational and time management skills • Must reside in the same assigned territory • May be required to travel greater than 50% of the time • Bachelor's degree in Nursing preferred • Clinical experience in geriatrics and/or managed long-term care preferred • Experience using multiple languages may be required based on operational needs • Bilingual speaking and writing skills preferred • Case Management Certification preferred

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs • Annual Influenza vaccination provided/required for designated positions during Influenza season • Flexible hours, including possible evenings and/or weekends as needed