The Nurse Care Manager serves as the overall care navigator for CPHL all LOB members, coordinating a continuum of care for all medical, behavioral and social service needs and is responsible for coordinating care management and the Interdisciplinary Team for assigned members. The Nurse Care Manager is the leader of the Interdisciplinary (IDT) Team, which is responsible for the overall management and coordination of care of members enrolled in CHPL programs. The Interdisciplinary team works collaboratively and is responsible for full array of functions including assessment and reassessment, person-centered care plan development, negotiation of care plan with member, caregivers, and providers, placement of services, tracking and monitoring service placement, monitoring of clinical status, reassessment and modification of care plan based on changes in member status. The Nurse Care Manager is the team leader and a facilitator with overall responsibility for assuring that the IDT is involved in the member’s care, that the person-centered care plan is addressing member needs, that services are appropriate and that there is regular and ongoing engagement with member, family, assessment nurse and other care team members.
Education and Experience:
Bachelor of Science in Nursing or advanced degree
Minimum 2 years Care Management experience with the geriatric population and /or minimum of 2-4 years clinical nursing experience in home health care or MLTC
Knowledge of UAS-NY assessment