Healthfirst Care Manager, Long Term Care - RN - Telecommuter in New York, New York
Company Overview: Healthfirst is a not-for-profit managed care organization sponsored by some of the most prestigious and nationally recognized hospitals and medical centers in New York. We are one of the fastest growing health plans in our area with over 1.25 million diverse members and a network of more than 30,000 providers and 4,000 employees. Our mission is to ensure that our members have superior healthcare and satisfaction; we significantly improve the health and wellness of the New York metropolitan area, while driving down the costs.
Employees shape our company and connect us to our communities. We look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers:
Dream Big, Plan Wisely
Break Down the Walls
Think Critically, Speak Up, Deliver with Pride
Inspire Through Trust, Lead By Example
Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.
Position Summary: The Nurse Care Manager plans and manages patient care with members, their families or significant others, and coordinates with the Primary Care Physicians and all members of the health care team to facilitate the patient's care across continuum of care episodes. Healthfirst's Long Term Care products include: Complete Care, FIDA, and MLTC.
Duties and Responsibilities:
Contributes to the development of patient-focused care and initiates the process in accordance with established guidelines.
Conducts assessments, develops treatment plans, performs defined interventions, and generates referrals to providers, community-based resources and appropriate social services.
Assesses member's physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including attending practitioner, utilization review staff, discharge planners, social workers, and coordinates care accordingly.
Functions as a clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage length utilization and coordination of resources.
Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments.
Evaluates and pre-authorizes request for inpatient/outpatient, specialty care, home care, Durable Medical Equipment, and transportation services from network and out-of-network providers in accordance with departmental guidelines.
Performs pre-authorization, concurrent and retrospective reviews of Medicare/Medicaid/Commercial members to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter. Responsible for compliance, in practice, with regulatory mandates.
Documents all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to ensure integrity of member services provided over the continuum of care and over time.
Associate’s degree in Nursing from an accredited program.
New York State Registered Professional Nurse license.
U.S. based work experience as a licensed RN in one or more of the following areas:
Acute, Sub-Acute, Long-Term Care (LTC)
Home care environment
Experience managing large case loads.
Occasional overtime as necessary.
Unexpired NYS driver’s license or NYS non-driver’s license ID (DMV Identification).
Must be able to pass Uniform Assessment System (UAS) training.
Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling).
The ability to troubleshoot or explain basic hardware and software errors and work with a Technician by remotely to perform step-by-step repairs.
Intermediate skills with a Corporate email system including using and sharing calendar rights, MS Word, MS Excel and electronic patient health information (PHI) database usage (medical records database).
Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables and use Pivot Tables.Ability to work remotely is dependent upon completion of training and passing audit scores, which varies by department. It is also contingent on the following telecommuter requirements:
Designated work area at the Telecommuting location away from the main flow of home traffic which meets OSHA and departmental policy.
Broadband solution will be a cable modem type using an Ethernet connection from a reputable provider such as Comcast, Cox Cable or Cablevision, TW or fiber service such as FIOS or AT&T Uverse offered by Verizon, AT&T or regional partners.
Usage of a DSL broadband is not recommended and will not be supported by Healthfirst’s Technical Services team, additionally; wireless is also not recommended with both options requiring prior approval of the division Vice President and Human Resources.
Separate designated work area away from the main flow of home traffic.
No dependent care while on duty.
Healthfirst has the right to a conduct home site inspection.
Random work activity audit reports will be conducted for all telecommuting employees analyzing performance and system activity on a given day.
The employee will be supplied with all necessary equipment and applications for business purposes only.
Fluency in speaking Spanish or Mandarin/Cantonese.
U.S. based work experience as a licensed Registered Nurse.
Experience working with a frail adult or elderly population.
Knowledge of current community health practices for the frail adult population and cognitive impaired seniors.
Knowledge of InterQual.
Thorough knowledge of current community health practices for the frail adult population and cognitively impaired seniors.
Care management including the concepts and philosophy and relevant standards of patient care.
Understanding of and sensitivity to cultural differences and needs of the community are essential. Adept at operating within a diverse and multi-cultural work environment and community of Members such as Spanish, Chinese, Russian, Creole and Korean.
Experience managing member information in a shared network environment using paperless database modules and archival systems.
Experience with multiple Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS), Federal Employee Program (FEP).
Knowledgeable of the values offered with integrated care.
Experience working in a team environment.
Must possess excellent judgment in order to resolve any grievances and/or concerns about patient care and safety.
Excellent interpersonal skills, especially the ability to relate well with seniors, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.
Excellent written communication and the ability to document grammatically correct notes.
Requires very accurate typing skills interacting through electronic documentation using multiple electronic PHI databases and security requirement tools such as encryption.
Experience exercising independent thinking and problem solving.
Ability to communicate on an individual basis as well as in a group setting. Adept at working in an environment with fast-past changing priorities while achieving departmental goals and objectives.
Ability to prioritize.
As a representative of CompleteCare effective interpersonal skills must be demonstrated consistently while interacting with members/families/support staff for daily collaboration on care plans.
Requisition ID 2017-15346
Job Locations US-NY-New York
Department Name Care Management - Complete Care
Equal Opp Statement -
Healthfirst is an Equal Opportunity Employer and does not discriminated against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.
Reasonable accommodation statement -
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 1-800-401-6000. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.