Description and Requirements

The Complex Care, Care Manager plans and manages behavioral and/or physical care for high-risk, medically frail members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager is responsible for engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. The Care Manager works as a crucial part of an Interdisciplinary Team (IDT) assigned to members from a variety of lines of business, including Medicare, Medicaid, DSNP, HARP, etc. This role will operate in a hybrid capacity (field-based settings and telephonically) requiring 3-5 field visits per month in high-risk/medically frail member's homes or local healthcare facilities.

• Provides telephonic (and occasional onsite) care management to support the member's care needs to promote positive health outcomes.
• Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
• Attends Interdisciplinary Team (IDT) Rounds several times per week to discuss and review high-risk cases
• Conducts assessments to identify barriers and opportunities for intervention.
• As needed, conduct home visits to high-risk members who need additional interventions.
• Develops care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals.
• Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes.
• Liaise between service providers such as doctors, nurse practitioners, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed.
• Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes.
• Assists in identifying opportunities for alternative care options based on member needs and assessments.
• Evaluates service authorizations to ensure alignment and execution of the member's care and physician treatment plan.
• Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
• Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.
• Occasional overtime as necessary.
• Additional duties as assigned.

• NYS RN, or
• LCSW, LMSW, or licensed psychologist (any state)
• Ability to travel around downstate New York which includes; the 5 boroughs, Long Island, and Westchester

• Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing situations.
• Fluency in Spanish, Korean, Mandarin, or Cantonese.
• Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors.
• Experience managing member information in a shared network environment using paperless database modules and archival systems.
• Experience and knowledge of the relevant product line
• Relevant work experience preferably as a Care Manager
• Demonstrated ability to manage member panels and work effectively in a fast-paced environment
• Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
• High level of competency using Microsoft Excel, Word and Powerpoint, including the ability to manage large data sets and reports