We are one a prestigious managed care organization that provides high-quality health care coverage to individuals and families through a variety of government sponsored health insurance programs.
The bilingual English - Chinese Nurse Case Manager at a Managed Long-Term Care (MLTCP) reporting to the Clinical Manager ensures high quality community-based member care through appropriate allocation of member services and resources. Monitors and evaluates effectiveness of the care plan to ensure member/caregiver satisfaction with services. Acts as a resource to staff in the planning and delivery of outstanding member care.
Frequently communicates complex information and interacts through electronic documentation tools. This is a paperless work environment. Systems include but are not limited to; CCMS (CareEnhance Clinical Management Software), Sunguard MACESS Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (VPN), creating .pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word, Excel & Outlook).�
Essential Duties and Responsibilities:�
� Maintains ongoing telephonic communication with members and their caregivers to ensure a safe and appropriate care plan.
� Member & family education re: health management and community resources.
� Appropriately manages member care including but not limited to; coordination of benefits (Medicare & Medicaid), coordinating & monitoring all skilled services, durable medical equipment (DME) and community resources.
� Maintains oversight and communication with members and providers during inpatient acute, sub-acute and/or long-term admissions.
� Completes documentation in PHI database (CCMS) of all member care.�
� Intervenes to resolve any grievances and/or concerns re: member care and safety.
� Provides individual and group education and support to members and their families as needed. Maintains a current knowledge base of federal (Medicare) and state (Medicaid) regulations.�
� Conducts home and nursing home visits to ensure continuity of care and appropriate care management.
� Quality Improvement.
� Conducts performance improvements activities as needed.�
� Participates in Quality Management Program in order to support continued performance improvement.�
� Participates in the recommendation of studies for the annual Quality Plan.�
� Participates on committees that support performance improvement.
� Rotate "On-Call" duties to ensure 24/7 team response to member needs.
Other Duties and Responsibilities:�
� Identifies barrier and develops innovation solutions to ensure quality of member care.�
� Occasional need to work on-call (includes weekends and after hours) and/or overtime.
� Responsible for maintaining efficient communication within the team and knowing when and what to escalate to the clinical manager and/or senior management.�
� Other duties as assigned.
Required: Associate�s degree in Nursing.
Required licenses, certificates, etc.
Required: NYS Licensed Nurse
Work Related Skills and Experience:
� Complete fluency in reading, writing, and speaking in English and Chinese is required.
� Proficiency in navigating internet browsers, computer hardware, multi-tasking with multiple electronic documentation systems containing PHI, toggling between multiple software systems simultaneously and using security tools such as encryption.
� Intermediate Microsoft Word, Excel, Outlook, electronic medical records database, efaxing and electronic archiving skills are required.
� One year of experience as a NY licensed RN working in a home care environment or as a staff nurse in an acute, sub-acute or long term care (LTC) setting or managed-long term care (MLTCP).
� Must possess excellent judgment in order to resolve any grievances and/or concerns about patient care and safety.
� Requires very accurate typing skills and interact through electronic documentation using multiple electronic PHI databases and security requirement tools such as encryption.�
� Excellent interpersonal skills, especially the ability to relate well with seniors, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.
� Excellent written communication and the ability to document grammatically correct notes.�
� Understanding of and sensitivity to cultural differences and needs of the community are essential. Must be adept at operating within a diverse and multi-cultural work environment and community of Members such as Spanish, Chinese, Russian, Creole and Korean.
� Experience managing member information in a shared network environment using paperless database modules and archival systems.
� Experience working in a team environment, exercising independent thinking and problem solving.
� Ability to communicate on an individual basis as well as in a group setting.�
� As a representative of this company effective interpersonal skills must be demonstrated consistently while interacting with members/families/support staff for daily collaboration on care plans with Care Management Team (CMT).
� Ability to prioritize.
� Experience managing large case loads.
� Adept at working in an environment with fast-past changing priorities while achieving departmental goals and objectives.
� Ability to occasionally travel to a member's home for assessments.
� Occasional overtime required.
� "On-call" required.
� Thorough knowledge of current community health practices for the frail adult population and cognitively impaired seniors.�
� Care management including the concepts and philosophy and relevant standards of patient care.
While performing the duties of this job, this employee will be occasionally climbing, reaching, bending, walking, overhead lifting, balancing, standing, driving, traveling and lifting/carrying and pushing/pulling 1-10lbs. This employee will also be frequently sitting and keying.�
This employee will frequently be in an indoor environment.�