[Hiring] Case Manager, RN or Licensed Behavioral Health @company

Role Description

Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member’s case assignment.

• Uses a systematic approach to identify members meeting program criteria.
• Assesses for opportunities to educate, support, coach, coordinate care and review treatment options.
• Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions.
• Collaborates with interdisciplinary care team to develop a comprehensive care plan.
• Potential for cross training in DSNP line of business case management team.

Qualifications

• Associates degree required; Bachelor’s degree preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required; or LMSW; or LCSW; or LMHC.
• Minimum of three years of clinical experience required; Case Management experience preferred.
• Must demonstrate proficiency with the Microsoft Office Suite.
• Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Must demonstrate ability to work independently on a daily basis.
• Deliver efficient, effective, and seamless care to members.
• For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within two (2) years of hire.
• For incumbents aligned to Hospital to Home program only, active NYS RN license required with three years’ behavioral health experience; or LMSW; or LCSW; or LMHC required.

Requirements

• Handles physical health member clinical management programs.
• Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, and performs activities as directed by departmental policy and leadership.
• Implements the Case Management Process per department policies, procedures and guidelines.
• Screens members that fall within the defined populations served.
• Initiates case management, as outlined in the Case Management Program Description.
• Works in collaboration with members’ physicians and other health care providers.
• Assesses member/caregiver knowledge of illness and initiates appropriate education interventions.
• Collaborates with member/caregiver to determine specific objectives, goals and actions.
• Provides appropriate resources and assistance to members regarding health management.
• Participates in inter-disciplinary coordination and collaboration.
• Accepts responsibility for continuing education relative to professional growth.
• Participates in and promotes other health plan programs.
• Works collaboratively with all Case Managers.
• May work with internal and external stakeholders for value-based payment programs.
• Maintains high regard for member privacy in accordance with corporate policies.
• May participate in the orientation of new staff.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Benefits

• Compensation Range(s):
• Level I: E2: Minimum: $62,400 - Maximum: $96,081
• Level II: E3: Minimum: $62,400 - Maximum: $106,929
• Level III: E4: Minimum: $65,346 - Maximum: $117,622
• Actual salary will vary depending on factors including budget, prior experience, knowledge, skill, and education.
• Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
• Opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team on a case-by-case basis.