Registered Nurse Case Manager at New York

Job Description

• Review initial authorization requests and ongoing authorization requests for personal care services
• Review physicians orders and nursing/social assessments to evaluate medical necessity and level of personal care services required
• Re-direct members in-network, assuring a smooth transition top participating personal care agencies
• Refer authorizations requests and extensions of personal care that do not meet guidelines, in additional to out-of-network authorization requests to the Medical Director for review
• Work closely with the agency performing the nursing/social assessments to assure timely completion of forms, in accordance with regulatory timeframes
• Document authorizations in the Care Management System, and generate appropriate correspondence
• Telephonic communication with members and providers to assess ongoing healthcare /personal care needs
• Refer members to internal disease specific Case Management Programs, as needed.
• Assign duties to ancillary staff to assist in the administrative aspects of the personal care program
• Performs all other duties as required, requested or assigned.

Job Requirements

Please be advised that we are only considering nurses with the following:

• Registered Nurse, currently New York State license
• A minimum of two years experience in home care. Experience performing personal care assessments or supervising personal care preferred
• Two years managed care/case management
• Working knowledge of Medicaid/FHP/Medicare regulations
• Proficiency with the Microsoft Office Applications and the Internet
• Excellent written and verbal communication skills
• Good interpersonal, customer service, analytical and decision-making skills, with the ability to effectively prioritize and organize multiple tasks

Country: USA, State: New York, City: New York, Company: Pathway Medical Staffing.