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Centers Plan for Healthy Living (CPHL), 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. CPHL is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community.
The Complex Care Nurse Manager serves as the overall care navigator for CPHL’s FIDA, MAPD and D-SNP 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. For our FIDA Participants, the Complex Care Nurse Manager is the leader of the Interdisciplinary (IDT) Team, which is responsible for the overall management and coordination of care of members enrolled in the FIDA program. The same applies for our D-SNP members, where the Complex Care Nurse Manager serves as the point person who leads the Interdisciplinary Care Team (ICT). The Interdisciplinary Team for both the FIDA and D-SNP lines of business works collaboratively and is responsible for a full array of functions, including assessment and reassessment, person-centered care plan (PCSP) 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 Complex Care Nurse Manager is the team leader and facilitator with overall responsibility for assuring that the IDT or ICT 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. Due to the population we serve, there is a strong emphasis on Disease Management, particularly involving chronic illnesses that require ongoing education and monitoring.
Type of Experience:
Knowledge of current community health practices for the frail adult population, behavioral health and cognitively impaired seniors and disabled including knowledge of physical health, aging and loss, chronic disease processes, appropriate support services in the community, frequently used medications and their potential negative side-effects, depression, challenging behaviors, Alzheimer’s disease and other disease related dementias, issues related to accessing and using DMEs.
Understanding of and sensitivity to members cognitive ability, means of communication, cultural differences and needs of the community are essential. Must be adept at operating within a diverse and multi-cultural work environment and community of members such as Spanish, Chinese, Russian, Creole and Korean.
Graduate of a 2- 4 year accredited nursing program;
Active and unrestricted NYS RN license
Strong written and verbal communication skills.
Proficient in the use of Microsoft office Suite tools
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
Experience working within community based home health organizations
Experience working within a managed care environment
Specific Technical Skills
Required: Microsoft Office suite