Status: Full Time, ExemptThis position will utilize the essentials of an integrated utilization management and case management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the needs of medically complex Medicaid members. Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate education, coordination of care and resource allocation. The principal role of the position is to engage individual members and communicate with an established interdisciplinary team. The role requires review of a comprehensive assessment and development of a time tasking tool and an individualized person-centered plan of care. In addition, the position will provide guidance in understanding benefit coverage and navigating the health care delivery system. The overall objective is to create solutions to overcome barriers to care and assist the member to achieve optimum health and/or improved functional capability through the coordination of quality cost effective care. The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. Other duties as assigned by supervisor. This position may be worked either virtually (worked remotely from home) within a New York residency or at one of our office locations (Schenectady, Rochester, Tarrytown).POSITION QUALIFICATIONS Minimum Education:Current New York State Licensure as a Registered Nurse required.Bachelor's degree in nursing preferredCase Management Certification a Plus (ANCC or CCM)Certification in Case Management required within 24 months after hire.Minimum Experience At least 3 years of recent clinical and Case Management experience.Experience working in a Medicaid Long Term Support Program (LTSS) or Health Home required. Experience with Medicaid programs and benefits strongly preferredRequired Skills:Ability to professionally communicate with members, and all interdisciplinary team members.Excellent oral and written communication skillsDemonstrated clinical knowledge including an understanding of population health management and the case management process.Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.Ability to work in an energetic team environment.Experience with situations requiring strict adherence to confidentiality.Ability to solve problems while exhibiting clinical judgment and realistic understanding of the current environment.Ability to make independent decisions regarding resource utilization, and quality of care.Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or plan of care and be able to demonstrate good judgment when dealing with emotionally charged situations.Strong computer skills including working knowledge of Word, Windows based applications, typing and internet access
