RN Care Manager - Occasional - Days
Company: Mohawk Valley Health System
Location: Utica
Posted on: July 4, 2025
|
|
Job Description:
Job Summary The Care Manager is responsible for completing a
comprehensive assessment to determine the correct services and
benefits based on medical necessity for an enrollee. Provides plan
education, transition of enrollees to clinical services based on
Department of Health (DOH) guidelines. Care management providing
advocacy, coordination and oversight of all healthcare services for
an enrollee striving to deliver the best care at the right time and
in the most-cost effective while meeting quality outcome standards
for the enrollee case load assigned. Complies with all state and
federal regulations including Health Insurance Portability and
Accountability Act (HIPAA). Core Job Responsibilities - Identifies
and coordinates enrollee services as provided by the plan and
services that are not a benefit of the plan (Medicare Services). -
Completes comprehensive assessment using the DOH approved tool to
determine eligibility of medically necessary services. - Educates
and completes with enrollee all necessary consents and
documentation. - Initiates and carries out continuous assessment of
physical, emotional, social, cultural, economic, and environmental
needs of the enrollee and coordinates services for needs as
determined. - Observes the enrollee for changes in condition and
follows up with appropriate services or providers to attempt to
prevent disease exacerbations. - Develops, monitors and revises a
Plan of Care with the enrollee or enrollee’s designee that has
problem, enrollee centered goals and interventions. - Implements
orders for Durable Medical Equipment items and treatments as
prescribed by the physician, submitting and maintaining appropriate
medical orders and documentation. - Completes documentation per
company standards/policy utilizing an Electronic Medical Record
(EMR) system. - Participates in Marketing Activities as requested
by Executive Director or Designee. - Accepts assignments and
performs duties within their nursing scope of practice, seeking and
obtaining sufficient information/education necessary to function
effectively in the managed long term care setting. - Participates
in departmental and organizational committees and meetings as
applicable. - Participates in the orientation of new staff, mentors
peers, and promotes collaborative teamwork. - Performs all duties
and responsibilities in accordance with the Nurse Practice Act and
in accordance with the basic principles of professional nursing. -
Maintains a working knowledge of, and adheres to applicable
federal/state regulations including, but not limited to, patient
confidentiality, release of information, and HIPAA. - Performs
other related duties as requested by the Executive Director or
Clinical Services Manager. - Clarifies issues and actively
addresses concerns in a timely manner. - Ability to manage
conflict, stress, and multiple simultaneous work demands in an
effective, professional manner. - Ability and willingness to
self-motivate, prioritize, and be willing to change processes to
improve effectiveness efficiency. Adapts to changing enrollee or
organizational priorities. - Ability to make independent decisions
in accordance with established policies and procedures. - Performs
related duties as assigned. Education/Experience Requirements
REQUIRED: - Computer literacy, including but not limited to data
entry, retrieval, and report generation. - Excellent written,
verbal and listening communication skills. - Strong organizational
and time management skills. - Ability to work with
patients/families of all ages and in a variety of settings,
including inpatient facility and patients’ homes presenting diverse
physical conditions and social/cultural environments. - Ability to
drive to and from a variety of settings in varying weather
conditions. PREFERRED: - 1-2 years in community based care or
health care area that cares for the community population.
Licensure/Certification Requirements REQUIRED: - Licensed and
currently registered to practice as a Registered Professional Nurse
or BSN in New York State, with preferred 1-2 years in community
based care or health care area that cares for the community
population. - Valid New York State driver’s license and personal
vehicle. - Current Basic Life Support (BLS) Certification.
Disclaimer Qualified applicants will receive consideration for
employment without regard to their age, race, religion, national
origin, ethnicity, age, gender (including pregnancy, childbirth, et
al), sexual orientation, gender identity or expression, protected
veteran status, or disability. Successful candidates might be
required to undergo a background verification with an external
vendor. Job Details Req Id 92468 Department CARE MANAGEMENT
SERVICES Shift Days Shift Hours Worked 8.00 FTE 0.19 Work Schedule
HRLY NON-UNION-8 HR Employee Status A7 - Occasional Union Non-Union
Pay Range $31 - $45 Per Hour
Keywords: Mohawk Valley Health System, Utica , RN Care Manager - Occasional - Days, Healthcare , Utica, New York