Job Description
Care Solutions' goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
Care Solutions is seeking RN Care Manager
Join the excitement in support of our MLTC and Medicare Advantage Plan businesses!
Centers Care Solutions (CCS), is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CCS is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community
The Care Manager works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. Through interventions such as complex case management and utilization management, the care manager will ensure coordination of health care services, member education, and preventative interventions.
PRIMARY RESPONSIBILITIES:
• Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
• Develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary
caregiver, the primary and attending physicians, and various other providers involved in the member’s care.
• Ιnitiates utilization review for preauthorization and post service reviews
• Utilizes knowledge of community resources and the member’s benefit structure
• Interacts with providers and facilities in a professional, respectful manner
• Recognizes quality of care issues and escalates the issues appropriately
• Assists members with the coordination of services from various settings as appropriate
• Complies with all CCSs standards for documentation
• Participates in case rounds
• Participates in on call coverage
• Participates in other meetings as requested
• Participates in quality improvement initiatives
• Other duties as assigned
Required:
• Active and unrestricted RN license
• Strong written and verbal communication skills
Preferred:
• Bachelor of Science in Nursing
• CCM certification
• Knowledge of Milliman or InterQual criteria
• Experience providing care in the home setting
• Experience working within a managed care environment
• Bengali/Arabic/Chinese Languages Preferred
Care Solutions is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.
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