Req Number 001E6C
Job Category Registered Nurse
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.
Collaborates with the multidisciplinary team and the nurse assessors to validate the care treatment plan.
Monitors and updates the effectiveness of care treatment plan as the member’s needs change.
Participates in weekly care coordination meetings to address member’s needs, as identified.
Coordinates patient’s plan of care through case management of services and reports significant changes.
Completes all documentation in accordance with the policies and procedures of North Shore
LIJ Health Plan, NY State and Federal regulations.
Provides and documents the authorization and reauthorization for services.
Performs job functions while ensuring quality, member safety and satisfaction in a fiscally responsible manner consistent with the health plan’s mission and vision.
Performs related duties, as required.
*ADA Essential Functions
·Graduatefrom an accredited Schoolof Nursing.Bachelor’s Degree in Nursing, preferred.
·Currentlicense to practice as a Registered Professional Nurse in New York State.
·Validdrivers license may be required, as determined by operational/regional needs.
·Minimumof one (1) year medical/surgical nursing experience, required. Managed Careexperience, preferred.
·Knowledgeableof the health insurance plan policy and procedures, Medicare and Medicaid planterms, CMS regulations, member eligibility requirements, utilization management, care coordination, protocols,regulatory and compliance.
Working knowledge of PC applications, required. Completeand remain current with training courses on various computer applications andassessment tools.