330 West 42nd Street
The 1199SEIU Benefit & Pension Funds provide comprehensive health, pension, and quality of life benefits to unionized workers represented by 1199SEIU United Healthcare Workers East. We are among the largest labor-management funds in the nation, covering 400,000 members and their families.
If you’re ready for the brightest career future, join us in this excellent opportunity to showcase your talents. We are currently seeking an experienced Nurse Case Manager for our Care Management department.
- Use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide, ongoing coordination and management of service delivery through an integrated case management approach
- Provide comprehensive telephonic case management to targeted population who are at risk for admission and to medically complex patients to develop a tailored plan of care that supports the needs of the patients, influences adherence to treatment, assist with discharge planning and care coordination to ensure optimal outcomes
- Apply nationally recognized clinical evidence-based guidelines and best practices approach to identify and address gaps in care
- Communicate effectively with members, physicians, and providers; facilitate, advocate, and educate on the disease process; be a liaison and provide referrals to other departments and programs as needed
- Use of information technology; Navigate within care management application and document management systems and maintain accurate documentation of case management assessment, planning, goals and interventions
- · Act as a Subject Matter Expert based on particular disease management areas of expertise: lead ongoing staff training, provide information regarding medications updates and continued education
- Interpret reports, understand trends and target specific high risk population, provide recommendations, generate outcomes.
- Promote active involvement and initiative to members regarding their health care management and navigating health care delivery systems in order to preserve benefit resources
- Authorize vendor services using clinically proven criteria to make consistent care decisions
- Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
- Responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operations
- Perform additional duties and projects as assigned by management
- Valid New York State Registered Nurse (RN) required
- Minimum three (3) years Medical/Surgical experience plus a minimum of two (2) years Case Management/Disease Management experience required
- BSN and Certification in Case Management a plus
- Knowledge of HEDIS, NCQA, QARR a plus
- Strong knowledge of industry standard Case Management criteria (Millman Care Guidelines,Interqual), Medicare and Medicaid coverage guidelines, health claims processing, medical coding and interpreting provider contracts
- Excellent verbal and written communication skills, problem-solving, clinical assessment, care planning skills, and independent decision-making capability
medical, dental, prescription, no copays, tuition reimbursement, child care
Minimum Education Required
How To Apply
We offer a competitive salary, an excellent fully employer-paid comprehensive benefits package and talented professional colleagues. For consideration and to apply, please mention you saw this ad in Idealist. We are an Equal Opportunity Employer.