Job Title: Case Manager
Work Hours: 8:30 AM - 5:00 PM EST
Languages: Bilingual in any language highly preferred
Pay: $100,000 + benefits
License Required: Must be Licensed RN, LCSW, LMSW in NY STATE
Summary: As a Case Manager at National Healthcare Organization, your role is to manage and coordinate healthcare services for our members, ensuring they achieve optimal clinical, financial, and quality of life outcomes. You will work with members to create and implement integrated care plans, monitor their progress, and ensure consistent, cost-effective care in compliance with all state and federal regulations.
- Identify members who may benefit from case management services proactively.
- Conduct assessments of member needs by gathering information from various sources.
- Assess and manage members according to established criteria.
- Develop and implement personalized case management plans in collaboration with members, caregivers, physicians, and other healthcare professionals.
- Continuously monitor and evaluate the effectiveness of care plans, making necessary modifications for optimal outcomes.
- Promote integration of services, including behavioral health and long-term care, for enhanced continuity of care.
- Conduct face-to-face or home visits as required.
- Maintain department productivity and quality measures.
- Manage and complete assigned work plan objectives and projects in a timely manner.
- Demonstrate dependability and reliability.
- Maintain effective team member relations.
- Adhere to all documentation guidelines.
- Attend regular staff meetings.
- Participate in Interdisciplinary Care Team (ICT) meetings.
- Assist in orientation and mentoring of new team members.
- Maintain professional relationships with the provider community and internal and external customers.
- Conduct oneself in a professional manner at all times.
- Maintain cooperative and effective workplace relationships and adhere to company Code of Conduct.
- Participate in appropriate case management conferences to enhance skills and abilities.
- Comply with required workplace safety standards.
- Demonstrated ability to communicate, problem-solve, and work effectively with people.
- Excellent organizational skills, including the ability to manage multiple priorities.
- Proficiency in working independently and handling multiple projects simultaneously.
- Strong analytical skills.
- Knowledge of applicable state and federal regulations.
- Familiarity with ICD-9, CPT coding, and HCPC.
- SSI, Coordination of Benefits, and Third Party Liability programs and integration.
- Familiarity with NCQA standards, state/federal regulations, and measurement techniques.
- In-depth knowledge of CCA and/or other Case Management tools.
- Ability to take initiative and see tasks to completion.
- Computer skills and experience with Microsoft Office Products.
- Excellent verbal and written communication skills.
- Ability to abide by company policies.
- Able to maintain regular attendance based on the agreed schedule.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
- Skill in establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers, and customers.
- Bachelor's degree in Nursing or a Master's degree in Social Work, or Health Education. A combination of experience and education will be considered in lieu of a degree.
- 1+ years of clinical experience with case management experience.
- Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker (LCSW) or Advanced Practice Social Worker (APSW) in good standing.
- A combination of experience and education will be considered in lieu of LCSW or APSW.
- Must have a valid driver's license with a good driving record and be able to drive locally.