Care Manager -RN

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