PART TIME - 20 HOURS PER WEEK
Geriatric care focus partnering with local geriatric practitioner.
This position assists in ensuring that quality, cost-effective care is delivered to members of all product lines of HealthNow NY Inc. The incumbent will assist in containing the cost of health care services by detecting, resolving and preventing improper utilization of member benefits. This position will also assess, plan, implement and evaluate the options and services to meet an individual's health needs.
Primary Job Duties:
- Acting as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services. This is accomplished by using communication and available resources to promote quality, cost-effective outcomes in accordance with available contract benefits.
- Exhibits and applies clinical understanding of the medical diagnosis(es), case management processes, and psycho-social needs of members and their support system toward the development of an appropriate treatment plan in conjunction with the member's physician(s) and other pertinent allied health professionals.
- Works collaboratively and communicates clearly and professionally with physicians, providers, co-workers and other members of the health care team in order to carry out the established plan of care.
- Demonstrates a thorough understanding of and applies the principles/standards of URAC and NCQA, Medical Services initiatives, and Strategic Business Unit goals.
- Identifies areas for potential cost savings, quality improvement and workflow efficiencies.
- Ability to work both as a team member and independently, demonstrating sound problem solving techniques.
- Local travel daily/weekly to practice site required.
- Excellent time management skills
- Excellent verbal and written communication skills
- Ability to work effectively with minor supervision
- Must be able to work in a fast-paced environment with daily work processing deadli
- High energy level and ability to project enthusiasm
- Persuasive communication style
- Polished, professional image and reputation
- Demonstrated customer service orientation
- Demonstrated personal accountability
- Knowledge of MS Word, Excel, Access, and Internet preferred
- Knowledge of case management, managed care, health insurance industry, and the provider community a plus
- CCM designation required within 3 years of accepting position.
- 3 years clinical experience, 1 year of which must be in a hospital setting.
- Multi-state RN licensure preferred.
- Registered Nurse
- Certified Case Manager
HealthNow New York Inc. - 13 months ago