Care Manager RN (MLTC) - Health Plan

North Shore-Long Island Jewish Health System

Provides care management through a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet a member’s health needs through communication and available resources, while promoting quality cost-effective outcomes. Maintains members in the most independent and safe living situation possible; ensures consistent care along entire health care continuum by assessing and closely monitoring members needs and status. Authorizes/coordinates services within a capitated managed care system. Closely communicates and collaborates with the member, primary care practitioners, interdisciplinary team and family members.

1. Collaborates with the multidisciplinary team and the nurse assessors to validate the care treatment plan.

2. Monitors and updates the effectiveness of care treatment plan as the member’s needs change.

3. Participates in weekly care coordination meetings to address member’s needs, as identified.

4. Coordinates patient’s plan of care through case management of services and reports significant changes.

5. Completes all documentation in accordance with the policies and procedures of North Shore - LIJ Health Plan, NY State and Federal regulations.

6. Provides and documents the authorization and reauthorization for services.

7. Performs job functions while ensuring quality, member safety and satisfaction in a fiscally responsible manner consistent with the health plan’s mission and vision.

8. Performs related duties, as required.

*ADA Essential Functions

*Graduate from an accredited School of Nursing. Bachelors Degree in Nursing, preferred

*Current license to practice as a Registered Professional Nurse in New York State

*Valid drivers license may be required, as determined by operational/regional needs.

*Minimum of one (1) year medical/surgical nursing experience, required. Managed care experience, preferred

*Knowledgeable of the health insurance plan policy and procedures, Medicare and Medicaid plan terms, CMS regulations, member eligibility.

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