RN Case Management Specialist
Location: Buffalo New York
Description: HealthNow New York Inc. is currently seeking to employ RN Case Management Specialist right now, this occupation will be placed in New York. For complete informations about this occupation opportunity please read the description below. Position Summary:
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, coordinate, implement, monitor, and/or 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 (in related discipline) 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) a! nd 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.
For Behavioral Health positions: Facilitates integration of behavioral health case management into the member's overall medical treatment plan. Educates member about mental or physical illness, abuse, medication, or available community resources.
For Inpatient Clinicians: Facilitates integration of inpatient care coordination and transition of care into the member's overall m! edical treatment plan; Supports and educates members and families regarding inpatient processes as needed; Communicates and facilitates post acute member needs.
Required Skills
Primary Skills/Knowledge:
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 deadlines
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
Required Experience
Preferred Education:
Bache! lors Degree (Nursing)
Preferred Experience:
CCM des! ignation 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. Associates degree considered with RN and equivalent experience.
Alternate Education:
Associates degree (Nursing)
Working Conditions:
Must be able to work in an office environment
Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
PPD Skin Test may be required by healthcare facility for onsite facility work
Required Licenses/Certifications:
Registered Nurse
Certified ! Case Manager
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to HealthNow New York Inc..
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This occupation starts available on: Thu, 01 Aug 2013 07:51:14 GMT