Care Manager -RN

Posted: June 23, 2022

Great Lakes Integrated Network (GLIN), formed as Optimum Physicians Alliance in 2012, is a Buffalo-based, physician-led independent physicians association (IPA) consisting of approximately 600 physicians in the areas of primary and specialty care. The mission of GLIN as a Clinically Integrated Network is to work as a community of providers to accelerate smart, patient-centered and value-based medicine, with the goal of building a healthier WNY community. We do this through network-wide data-sharing and providing services to all of our community-based providers and the patient population served by GLIN network providers. GLIN is seeking a Care Manager- RN to join our team.

The Care Manager (CM) RN will lead a multidisciplinary healthcare team in a primary care / telephonic setting, focusing on coaching and coordination of care for patients needing navigation, addressing nursing care needs and follow up after clinical events. The CM RN will identify the needs of patients at risk and assist the providers to develop processes for managing the patient’s preventative care, transitions of care, and or chronic disease management using defined protocols as well as their own sound clinical judgement. This person will promote patient-centered care, working with primary care providers and medical home team members. The CM RN is a key role in the care coordination of patients attributed to value based contracts.

 

Duties and Responsibilities (including but not limited to)

  • Evaluates patients for care management services, determines appropriate level of care coordination management for the patient
  • Complete a comprehensive assessment to identify patient risk and develop a care plan utilizing clinical expertise and judgement to evaluate needs for alternative services as needed
  • Work collaboratively with physicians and in-house resources including pharmacists, registered dieticians, social workers and other disciplines to create a person-centered care plan with measurable SMART goals
  • Interact with patient, family, providers, and multidisciplinary care team to assess the options of care including use of benefits ad community resources to update care plan. Utilize developed systems, processes, and initiatives to engage patients in relevant case management activities necessary to promote wellness and care at the right place and time.
  • Supervise and act as a resource for non-clinical staff [i.e. care coordinators, social workers].
  • Coordinate necessary referrals and authorizations within care management areas
  • Facilitate the information flow between hospital, long-term care, specialists and home health representatives and the care team
  • Verify that members are screened for behavioral health concerns (depression / substance abuse) and are receiving appropriate screening and behavioral health interventions.
  • Attend required training and collaboration sessions [i.e., learning sessions, care management meetings, and practice team meetings] as scheduled.
  • Develop constructive relationships with internal GLIN population health team members, participating providers, and community resources.

Qualifications or Education, Training and Experience

  • New York State Licensed RN
  • Bachelor’s degree in nursing preferred; Associate degree in nursing is minimum requirement.
  • 1-2 years’ experience in acute inpatient, rehabilitation, sub-acute, skilled facility, home care, ambulatory care management, or managed health plan.
  • Preferred: Certified Case Management (CCM) certification
  • Preferred: Care/Case Management experience

 Working knowledge of the following required:

  • Principles of utilization management; care management principles; basic knowledge of health plan contracts and benefit eligibility requirements; Hospital structures, Managed Care and payment systems
  • Proficiency in EMR system(s), Outlook and data entry experience preferred
  • Basic PC skills (MS Word/Outlook/PPT/Excel)

Examples of Competencies:

  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to analyze and solve problems; requires details, data and facts that must be analyzed and challenged prior to making decisions.
  • Ability to clearly communicate medical information to professional practitioners and/or the public.
  • Excellent organization, prioritization, follow up, analytical and time management skills with ability to handle multiple priorities and deadlines.
  • Ability to deal with multiple interruptions on a continual basis that must be met with a friendly exchange with others.
  • Ability to develop and implement new approaches to improve processes, procedures, or the general work environment.

Equal Employment

Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and to lead New York in provider and patient satisfaction. Great Lakes Integrated Network (GLIN) values diversity, inclusion, and equity as matters of fairness and effectiveness. We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feel welcomed and engaged.

 Great Lakes Integrated Network is an Equal Opportunity Employer

Please send cover letter and resume via email to employment@opawny.com and in the subject line please indicate the position you are applying for.

Or Mail:

Great Lakes Integrated Network

C/o Employment

726 Exchange Street

Suite 522

Buffalo, NY 14210

For additional information please call 1-844-769-5879 or email opainfo@opawny.com

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