Case Manager, RN (Hospital to Home)

Job Description:

Summary:

The Case Manager H2H (RN) is responsible and accountable for coordinating the care of CDPHP members who meet criteria for services across the continuum of care. Activities focus on the successful transition of care for CDPHP members who have been hospitalized and are being discharged, with a focus on readmission avoidance. Specific activities include member outreach, medication review, identifying barriers to care, care planning and collaboration with providers. Case Managers will also provide education and support to members who have ongoing chronic health needs, they will also serve as a resource to answer day-to-day clinical questions from members and other CDPHP business areas.

The Case Manager H2H will navigate a variety of applications and platforms in the daily administration of work. They must combine strong clinical knowledge and critical thinking to coordinate and support a care plan that will monitor quality medical care for the member population serviced by CDPHP. This is a telephonic role.

Essential Accountabilities:

* Provide a well-coordinated care experience for patient/families, including, effectively monitoring length of stay, readmissions and coordinating the activities of multiple disciplines utilizing nursing judgment.

* Collaborate with members/families, providers, medical staff, utilization review staff, embedded case managers and/or others to coordinate a safe transition from the hospital setting.

* Perform detailed medication reviews, identify discrepancies and communicate with providers to resolve discrepancies. Support member to ensure they are taking medications as prescribed.

* Build relationships with hospitals and provider offices to allow for collaborative information exchange and prompt appointment setting requests.

* Advocate for members to obtain the most appropriate health care services in collaboration with members of the health care team.

* Facilitate communication among different disciplines to assist in the coordination of care. If embedded, meet with CDPHP members at designated facilities to assist them with their anticipated discharge needs.

* Develop care plans that include mutual and realistic goals, interventions, and expected outcomes.

* Revise and adjust the care plan to fit the needs of the member based on continuing assessment, medication changes or member's condition.

* Effectively utilizes community resources and community support systems to reduce avoidable readmissions

* Identify and address social determinants of health (SDOH) and facilitate referrals to Social Work Case Management, Behavioral Health and/or psychosocial community support systems or resources.

* Identifies variations in care delivery and notifies manager and/or supervisor of any patterns or trends.

* Engage, communicate with and coach patients telephonically and/or face-to-face. Educate members (family/caregivers) regarding their disease process and self-management strategies. Evaluate understanding of disease processes to prevent further complications.

* Educate members, families and health care providers regarding benefits, availability of services, community resources, alternative funding, and health care alternatives.

* Identify and facilitate access to social service agencies, community organizations, patient support groups, and other adjunct services to minimize and prevent inappropriate hospital stays and maintain maximum achievable health status.

* Maintain comprehensive computerized records of all care management activities.

* Participate in team and office meetings as needed.

* Maintain departmental standards for all duties as outlined by CDPHP policies and procedures.

* Precept new employees to the department.

* Volunteer at health fairs, workshops and other corporate events and present in-services when appropriate.

* The employee agrees to comply with CDPHP's Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Resources or the Chief Executive Officer.

* Perform other duties as assigned.

Minimum Qualifications:

* Associates degree or two (2) years of equivalent experience required.

* Registered Nurse with a current New York State license is required.

* Bachelor's degree in Nursing preferred.

* Certified Case Manager (CCM) certification preferred.

* PRI (Patient Review Instrument) certification preferred.

* Minimum three (3) years clinical experience is required.

* Experience with chronic condition management required, experience with diabetes and heart disease is preferred.

* Case management experience preferred.

* Experience working with health, social service and funding resources, including community agencies and alternate care delivery systems is preferred.

* Experience in home care, medical office setting, hospital or managed health plan preferred.

* Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint are required.

* Demonstrated ability to provide case management for complicated members with multiple comorbidities and chronic diseases.

* Demonstrated ability to work collaboratively on a team.

* Demonstrated ability to communicate effectively with members with varying levels of education, health literacy and understanding.

* Demonstrated ability to work with diverse population.

* Ability to navigate system applications with accuracy.

* Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions.

* Demonstrated ability to interact with providers, members to positively impact the quality of patient care.

* Demonstrated ability to manage multiple projects in conjunction with a frequently changing patient caseload.

* Demonstrated ability to work with and maintain confidential information.

* Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.

* Excellent verbal and written communication skills.

* Flexibility to adapt to a changing and fast-paced environment.

* Ability to travel to a variety of sites across CDPHP service area, during regular business hours, evenings and possibly weekends may be required.

* Valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile required.

* Annual Physical assessment, as well as any other clinical requirements, will be required by the designated facility.

* Spanish speaking preferred.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

E2: Minimum: $62,400 - Maximum: $ 96,081

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.