RN Care Manager- MLTC
Company: Elderwood Health Plan
Posted on: October 14, 2021
Join Our Team: Join our strong and growing company today!
Health Plan is seeking an RN Care Manager – MLTC to join our
incredible growing team of professionals in Monroe County,
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Schedule w/ no weekends or overnights
Dental & Vision upon 1st of month following 60 days of
- Up to 140
hours (19 days) of PTO time PLUS six (6) holidays within the 1st
retirement plan with vested employer match up to 4%
In the role
of an MLTC Care Manager (RN), you are a critical resource for our
members as you are responsible for assessing a member’s home health
and level of care needs, assisting them in accessing necessary
covered services, providing referrals and coordinating other
medical services in support of their member centric service
The RN Care
Manager also assists our members with obtaining needed medical,
social, educational, psychosocial, financial, and other services,
irrespective of whether the needed services are covered Elderwood
Health Plan. You will partner with the Social Worker to facilitate
the MLTC care model by coordinating services and community
resources and meeting member socioeconomic needs to support the
quality of life. The RN Care
Manager partners with the Social Worker to facilitate the MLTC care
model by coordinating services and community resources and meeting
member socioeconomic needs to support the quality of
critical competencies or tasks of this role include, but are not
- Provide a
care management process of assessment, planning, facilitation, and
advocacy for options and services to meet a member’s home health
needs through collaboration, communication, and available
resources, while promoting quality cost-effective
comprehensive (physical, emotional, psychosocial, and
environmental) assessments in the Member’s home to assess potential
enrollees’ appropriateness for Managed Long-Term Care (MLTC), or to
reassess a member’s status and needs.
and maintaining of a person-centered service plan based on a needs’
assessment identifying the strengths, capacities, preferences and
long-term goals of the Member, resources available to meet member
needs and ongoing revisions to the service plan based on the
changes in the Member’s condition and status
in the utilization review process and evaluating to determine if
the member’s condition and needs meet criteria for covered services
and provide service prior authorization or denials to health care
financial, legal, or medical issues and refer Members to social
work or other professionals for estate planning, living wills,
family trust, crisis services, and other programs
- Ensure that
documentation in the care management record meets all applicable
professional standards, using an EMR for each observation, verbal
report, or interaction with the Member, Member’s caregiver/family,
PCP or other provider, whether by home visit, telephonic, or
identification of incipient problems or significant changes in
Member conditions to initiate early intervention and strategies to
prevent or more quickly treat chronic care
in Disease Management, Utilization Management, and Quality
use the UAS-NY assessment tool. Previous UAS-NY is desired, but
not required. Training is available.
- Use of
standard patient assessment instruments such as PRI,
- BSN, AAS
Degree or diploma in Nursing and Case Management
Certification is preferred
- At minimum,
a current New York State Registered Nurse License and a
valid NYS Driver’s license
- Must have
current knowledge of comprehensive case management, chronic care
and geriatric issues, and best practices.
- Minimum of
three (3) years nursing experience in home care, case management,
discharge planning or managed care
- Minimum of
one (1) year experience working with a frail or elderly
- Minimum one
year experience with health assessments
Demonstrated favorable interpersonal and assessment
Ability to identify patterns, connections and underlying themes
that lead to understanding and resolving complex problems or
Ability to focus on specific disease processes/health issues and
identify strategies to promote client focused care
Familiarity with provisions of governmental and accrediting agency
health plan requirements.
Familiar with applying clinical criteria when determining medical
necessity and/or benefit administration.
possess computer skills, including working knowledge of Electronic
Medical Records (EMR), Microsoft Office Suite (365)
Ability to meet established productivity goals.
- Must have a
safe driving record and dependable car, as well as willingness to
travel throughout the EHP service area & perform day travel w/in
assigned geographic areas. A DMV motor
vehicle report will be reviewed.
- Must be in
good standing with the Medicare and Medicaid programs. This
includes a criminal background check.
good speaking and listening skills.
skills are preferred, but not required.
- Must be
free of communicable disease
- May be
exposed to unsanitary conditions in some home settings.
- May be
exposed to high crime areas within the service
exposure to weather and temperature extremes when visiting Member
Elderwood expects all current and new
employees to be vaccinated against COVID-19. If hired, you will be
required to provide proof of vaccination. Employees may
request a medical or religious exemption from vaccination.
EOE Statement: WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and
employees are considered for positions and are evaluated without
regard to mental or physical disability, race, color, religion,
gender, national origin, age, genetic information, military or
veteran status, sexual orientation, marital status or any other
protected Federal, State/Province or Local status unrelated to the
performance of the work involved.
Keywords: Elderwood Health Plan, Rochester , RN Care Manager- MLTC, Other , Spencerport, New York
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