Centers Plan for Healthy Living

  • I-SNP Care Manager

    Job Locations US-NY-Staten Island
    Posted Date 1 month ago(10/15/2018 2:18 PM)
    ID
    2018-1341
    # of Openings
    1
  • Overview

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    This position supports the I-SNP NP through a collaborative process for options and services to meet a member’s health needs.   Allows for appropriate allocation of member benefits and resources through a collaborative partnership with participating nursing facilities and providers. Liaison for discharge planning activities by insuring documented plan for each acute discharge and coordination and facilitation of non-emergent services and routine care planning and implementation.

     

    Responsibilities

    1. Facilitate authorizations and scheduling of appointments.
    2. Ensures that the member has a seamless transition from one level of care to another based on regulatory requirements, Department policy & procedures and established best practice.
    3. Communicate daily with hospital staff regarding admissions and discharge of I-SNP members.
    4. Communicate with physicians to ascertain their plans for a timely discharge.
    5. Manage and collaborate with hospital staff on development of discharge needs / plan
    6. Educate hospital staff of I-SNP Model of Care and clinical skill level of nursing facility to promote early discharge to nursing facility.
    7. Assist as needed with effectuating discharge plan including identification of participating network providers and providing authorizations as required.
    8. Obtain and communicate discharge plan, medication list and PRI to NP care manager.
    9. Meet with hospital staff as needed
    10. Document discharge plan as an ongoing review.
    11. Participants in and present cases at weekly case review meetings.
    12. Will document recommendations discussed in case conference within one business day and coordinate as needed.
    13. Ensure proper utilization of all benefits including skilled care services and level of care changes.
    14. Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner, and facilitate changes as needed
    15. Facilitate member access to appropriate medical and specialty providers
    16. Collaborates and assists care team in identifying level of care changes
    17. Ensures participating facilities are educated and comply with CPHL policies and procedures that ensure effective coordination of care as outlined in the model of care.
    18. Develops and facilitates collaborative partnerships with all members of the care team
    19. Work closely with Clinical Manager on development and implementation of methods, policies and procedures to improve the Departments’ efficiency and overall effectiveness.
    20. Identifies and reports utilization trends and patterns monthly, quarterly and annually

     

     

     

     

     

     

    Qualifications

    Competencies

    • Excellent customer service, oral communication, writing, and presentation skills.
    • Ability to demonstrate effective critical thinking and problem solving skills.
    • Excellent leadership and interpersonal skills.
    • 2-3 years experience; discharge planning, managed care government programs, UM, application of standrad crieria (InterQual, Medicare LCP and NCP) in managed care and SNF/Long Term Care settings
    • Knowledge of Federal and State regulations, managed care regulations and concepts, and CQI methodologies
    • Ability to provide appropriate support and direction to facilitate collaborative efforts toward accomplishing established goals and objectives outlined in the I-SNP Model of Care.
    • Excellent knowledge of computer software programs including case management software and / or EMR.

    Supervisory Responsibility

    This position has no supervisory responsibilities.

    Work Environment

    This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, and photocopiers.

    Physical Demands

    This is largely a sedentary role..

    Position Type and Expected Hours of Work

    This is a full-time position. Days and hours of work are Monday through Friday, 9 a.m. to 5 p.m.   Some travel to hospitals and nursing facilities required

    Required Education and Experience

    • Bachelor's degree in nursing, NYS RN license and registration.
    • 3-5 years of clinical experience in a health care setting, preferably long term care.
    • Previous managed care experience required.
    • Working knowledge of utilization management, case management , subacute and long term care.
    • Knowledge of Medicare / Medicaid bemefits and regulations required.

    Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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