SUMMARY

The Registered Nurse (RN) Care Manager for Belong Health's DSNP program, is responsible for applying care management principles when engaging members and addressing coordination of the member’s health care services including developing and maintaining a collaborative relationship with provider practices, community-based resources, and the Belong Health team.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

• Responsible for providing clinical oversight to medically complex Medicare beneficiaries
• Orient new members to the Belong Health DSNP program and educate the member and/or caregivers on care management services.
• Advocate, empower, inform, and educate beneficiaries on self-management techniques.
• Conduct assessments to identify barriers and opportunities for intervention.
• Develop and implement the individual care plan (ICP).
• Lead interdisciplinary care team meetings.
• Collaborate with provider, social workers, discharge planners, and community-based service providers to coordinate care and achieve care plan goals.
• Document all care management activities in the appropriate system in accordance with internal and established documentation procedures.
• Work directly with members, their families and/or advocates, providers, and community service organizations on an ongoing basis to coordinate care and reduce barriers to care.
• Promote a culture of accountability and performance to both meet and exceed personal service vision goals and ensure timely and satisfactory resolution of highly complex, specialized, and non-routine customer issues.

SUPERVISORY RESPONSIBILITIES

This role does not have supervisory responsibilities.

REQUIRED PROFESSIONAL EXPERIENCE AND QUALIFICATIONS

• Nursing degree with an active, unrestricted license in the state of NY (RN).
• Working knowledge of Medicare and Medicaid programs and experience with regulatory requirements and reporting.
• Proficient in navigating multiple systems.
• Two (2) or more years’ experience in a health plan, health care organization, Community Based Organization, or social services environment.
• Previous care management experience.
• Understanding of the needs and dynamics of elder care services, disadvantaged, disengaged populations.
• Experience in participating in cross departmental projects and policy and procedure changes, including coordination of activities and initiatives across departments.
• Excellent customer service, problem solving, trend identification, and analytical skills, with a demonstrated ability to problem solve effectively and efficiently.
• Commitment to high ethical standards in all work; protects the privacy of member and company data and exercises discretion in handling confidential member information.
• Excellent oral and written communication skills, including presentation skills.
• Demonstrated PC skills using Microsoft applications.
• Strong active listening, issue assessment and problem-solving skills.
• Strong organizational and follow-through skills.

PREFERRED PROFESSIONAL EXPERIENCE AND QUALIFICATIONS

• Knowledge of community services and resources for elders and disabled preferred.
• Demonstrated experience in a managed care or HMO setting is strongly preferred.
• Bi-lingual Spanish speaking preferred.

EDUCATION AND TRAINING

•  A degree in Nursing is required.

LICENSE AND CERTIFICATION

• An active, unrestricted nursing license in the state of New York is required.
• Care Management Certification preferred.

HEALTH AND SAFETY

Belong Health and its partners require full vaccination for associates and select contractors who conduct work outside of their home on behalf of Belong Health and its partners. This applies to those who work within our facilities; interact directly with members and patients; attend in-person meetings or training; and/or represent Belong Health at events or volunteer activities. Medical and religious exemptions will be considered, and this policy will not supersede state or local laws. 

SALARY RANGE

• $80,000-$95,000