The Care Manager (CM) is responsible for reviewing, and approving Plans of Care, CANS-NY assessments and HCBS services. The CM is also responsible for the authorization of inpatient and DME requested by Medically Fragile and Care at Home children according to UM requirement set forth by the “office of Health Insurance Programs Principles for Medically Fragile Children. The CM works with Health Home Coordinators and LDSS/VCFA to ensure proper access, level of care, level of need and continuation of care for Medically Fragile and Care at Home children.
- Coordinates with Health Home Coordinators and LDSS/VFCA Care Managers to ensure that patient comprehensive treatment needs are met.
- Coordinates member’s service needs with community agencies.
- Provide education and coaching to members’ family.
- Conducts follow up quarterly assessment calls to Health Home Coordinators.
- Provide clinical guidance and support to assist member in achieving their goals.
- Have extensive knowledge of community resources/services.
- Prepares for and participates in all clinical rounds.
- Interacts with physicians and other members of the Providers’ Clinical Teams for discharge planning and required DME.
- Performs telephonic care review and authorization determinations for pre-admission and continuing care with hospitals, clinics and at home services.
- Determines appropriate level of care.
- Consults with Clinical Peer Reviewers when requests for services do not meet medical necessity criteria.
- Interacts with Clinical Peer Reviewers to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases.
- Provides information to members’ families, Health Home coordinators, LDSS/VFCA, clinical and HCBS providers regarding medical benefits.
- Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources.
- Recognizes quality of care issues and reports them appropriately through internal and external processes.
- Perform other duties as assigned by Medical Director, Director of Children’s Special Services and the Senior Director of Children's Special Services, and the Director of Children's Special Services.
Minimum Requirements
- Bachelor’s Degree required
- A valid NYS RN license
- A minimum of two year’s clinical experience in an acute care setting
- Experience using Interqual Guidelines required.
- Knowledge of medical care and HCBS services needed by medically fragile children.
Job Type: Full-time
Pay: $96,682.00 per year
Work setting:
Application Question(s):
- This position is hybrid 2x in the office at 50 Water Street in New York. Would this work for you?
Experience:
- Nursing: 2 years (Required)
- Case management: 1 year (Required)
- with children: 1 year (Required)
License/Certification:
- RN License in the State of New York (Required)
Ability to Commute:
- New York, NY 10004 (Required)
Work Location: Hybrid remote in New York, NY 10004