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Niagara Falls. RN Care Manager. Kalos Health. FT. 1st Shift. Benefits.

The Care Manager coordinates the care and service of selected member populations across the continuum of illness. They will serve to promote effective utilization and monitor health care resources within their group of members. Works with the Medical Director, Quality Assurance, Interdisciplinary team and Director of Clinical Operations to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health, well-being and satisfaction of all members under their purview.

Key Responsibilities:

In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establish case management objectives. Manages active cases based on case intensity and acuity. Handles more complex or delicate members and works with interdisciplinary team to effectively manage these cases. Active cases may Provides training and guidance to new Care Managers regarding policy & procedure, systemic tools, workload and care plan development. Interacts continuously with member, family, physician(s), other providers and the Kalos interdisciplinary team utilizing clinical knowledge and expertise to determine medical history, current status and the identification/facilitation of member needs. Assess the options for care including use of benefits and community resources to update the care plan. Utilizes clinical knowledge and expertise to determine medical history and current status. Assesses the options for care including use of benefits and community resources to meet member's needs reflective in the plan of care. Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
Maintains accurate records of case management activities in the electronic health record using clinical guidelines. Coordinates community resources with emphasis on medical, behavioral and social services. Applies case management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues. Ensures compliance with all state and federal regulations and guidelines in day-to-day activities. Promotes and adheres to the elements of the Corporate Compliance Program. Participates in regularly scheduled chart audits Performs special projects as assigned. Primary clinical contact for in-network providers (i.e. answering questions). Maintains compliance set forth by Director of Clinical Operations and Quality Manager Maintains regular communication with Director of Clinical Operations regarding status of the members under their survey. Participates in on-call, after hours' coverage. Assists in onboarding new care managers within their region(s).

Qualifications/Requirements:

Current NY State RN licensure. CCM certification preferred. 5+ years clinical experience, preferably in home health, physician's office or public health.
2 years' current case management or managed care experience preferred. Experience and knowledge with electronic health record software preferred.

Preferred Skills:

Bilingual skills a plus. Demonstrates effective communication methods to assist in training and to relate effectively to teams and management. Process improvement. Ability to work independently, handle multiple assignments and prioritize workload.
Demonstrates high level time management and priority setting. Strong oral and written communication skills.

To apply, contact the employer on-line: Web-site: https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=e31e741b-73fc-442f-b209-58c7f0ebea88&ccId=1262596328337&lang=enUS&selectedMenuKey=CurrentOpenings