RN Case Manager

Req #: 2699 Job ID: 14216 Job Location: New York, NY Zip Code: 10041 Category: Managed Care Nursing Agency: Elderplan Status: Regular Full-Time Office: Fully remote after training Salary: $90,000.00 - $110,000.00 per yearThe challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, Elderplan employees have an opportunity to make a positive impact on the quality of our health plan members' lives. $15,000 Sign-On Bonus or Student Loan Assistance!Why work for MJHS?: When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patients, residents and health plan members, and we will take care of the rest!Benefits include:Sign-on Bonuses OR Student Loan Assistance for clinical staff $15,000 Sign-On Bonus or Student Loan Assistance! FREE Online RN to BSN and MSN degree programs! Tuition Reimbursement for all full and part-time staff Dependent Tuition Reimbursement for clinical staff!Generous paid time off Affordable medical, dental and vision coverage for employee and family members Two retirement plans ! 403(b) AND Employer Paid PensionFlexible spendingAnd MORE! MJHS companies are qualified employers under the Federal Government's Paid Student Loan Forgiveness Program (PSLF) Responsibilities: Provides telephonic assessments of members identified as high risk for incurring hospitalizations or high dollarhigh volume procedures, through in-house referrals, health risk assessments, data mining, PCP referrals or member requests. Utilizes pre-determined assessments, workflows, standards of care, educational tools, and Medicare guidance to evaluate member's clinical status, assess self-careknowledge deficits, and to develop a plan of care to educate the membermember's representative to achieve independence in self-care. Monitors the plan of care and re-evaluates when goals are not met. Utilizes in-network providers, community based resources, and inter-agency programs (such as Hospice, Palliative care) when necessary. Uses discharge parameters to determine program discharge readiness. The Case Manager follows all workflows for pre-determined interventions for the Chronic Care Improvement Program, Quality Improvement Program, and Medication Therapy Management Programs as needed. Qualifications: Bachelor's degree in nursing (BSN) preferred; Associates degree accepted with extensive case management experience3-5 years of case management experience in a health care setting, preferably managed care setting.Working knowledge of utilization management, case management, MedicareMedicaid regulations. Specialized Knowledge and Skills, LicenseCertificationNYS RN license and registration.Excellent knowledge of computer software programs including case management software andor electronic medical records.Excellent customer service, verbal communication, writing, and presentation skills.Ability to demonstrate effective critical thinking and problem-solving skills.Excellent interpersonal skills.Knowledgeable in case management processes in managed care settingKnowledge of Federal and State regulations, managed care regulations, and conceptsAbility to provide appropriate support and direction to facilitate collaborative efforts toward accomplishing established goals and objectives.

Created: 2025-03-03