Registered Nurse Case Manager

  • New York, NY
  • Full-time

Company Description

Great opportunity to work with an established, cutting-edge, work-life balanced organization! If you want to be part of a team that works hard, takes pride in their work, and has a collaborative spirit, then please consider applying with us...we look forward to hearing from you...!
We welcome and look forward to your application.

Job Description

Nurse Case Manager


Use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide, ongoing coordination and management of service delivery through an integrated case management approach


  • Provide comprehensive telephonic case management to medically complex patients to develop a tailored case management plan that supports the needs of the patients, influences adherence to treatment, assist with discharge planning and care coordination to ensure optimal outcomes
  • Communicate effectively with members, physicians, and providers; facilitate, advocate, and educate on the disease process; be a liaison and provide referrals to other departments and programs as needed
  • Maintain accurate documentation of case management assessment, planning, goals and interventions
  • Interpret reports, provide recommendations, generate outcomes and acts independently to apply and use evidence-based clinical guidelines and best practices approach
  • Promote active involvement and initiative to members regarding their health care management and navigating health care delivery systems in order to preserve benefit resources
  • Authorize vendor services using clinically proven criteria to make consistent care decisions
  • Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
  • Responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operation

Qualifications

Valid New York State Registered Nurse (RN) required 

  • Minimum three (3) years Medical/Surgical experience including minimum two (2) years Case Management or Disease Management experience required
  • BSN and Certification in Case Management preferred
  • Basic knowledge of Microsoft Office systems preferred
  • Strong knowledge of industry standard Case Management criteria (Millman Care Guidelines, Interqual), Medicare and Medicaid coverage guidelines, health claims processing, medical coding and interpreting
    provider contracts
  • Excellent verbal and written communication skills, problem-solving, clinical assessment, care planning skills, and independent decision-making capability
  • Ability to manage competing priorities, multi-task with results oriented outcomes and work in a fast paced environment

Additional Information

Compensation: Commensurate with experience. All your information will be kept confidential according to EEO guidelines. Excellent benefits and other incentives provided.