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CareSource

Member-first health plan: Marketplace, Medicare, Medicaid

Registered Nurse Care Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeQueens, NY, USA

About the Job

Requirements

  • An associate degree in Nursing from an accredited nursing program is required.
  • Two years of experience as a registered nurse are required.
  • Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel, is required.
  • Knowledge of local, state, and federal healthcare laws and regulations, and company policies regarding case management practices, is required.
  • The employee must adhere to the code of ethics aligned with professional practice and to Case Management Society of America standards for case management practice.
  • The employee must have a current, unrestricted Registered Nurse license in New York.
  • The employee must have a valid driver's license, a vehicle, and verifiable insurance; employment is conditional on successful clearance of a driver's license record check.
  • Annual proof of influenza vaccination is required for designated positions during influenza season, October 1 through March 31; employees hired during that season have 30 days from hire to complete vaccination and verify immunization.
  • The employee must reside in the assigned territory, with exceptions potentially considered for business need.
  • The employee must be able to travel routinely between work locations and may be required to travel more than 50% of the time.
  • The employee must be able to work flexible hours, including possible evenings or weekends, as needed.

Responsibilities

  • Assess and closely monitor members’ needs and status to ensure consistent care across the health care continuum.
  • Authorize covered services and coordinate care regardless of payer.
  • Collaborate and communicate with members, families, caregivers, primary care practitioners, and the interdisciplinary team.
  • Work with members and families to maintain the most independent living situation possible.
  • Assess, plan, and provide continuous care management across hospital, sub-acute, long-term, and home settings.
  • Regularly assess members’ ongoing eligibility for services based on plan-specific criteria.
  • Conduct home visits as required to assess members’ living situations, cultural influences, functional needs, and cognitive needs.
  • Collaborate with the primary care physician and Inter-Disciplinary Team to develop the member’s Patient Centered Service Plan.
  • Ensure an appropriate and safe discharge plan for members leaving their plan.
  • Identify same-day grievances, investigate and document them according to plan policy.
  • Identify and present members with complex care management needs or difficult-to-manage situations at Intensive Care Management meetings.
  • Respond to member requests within designated timeframes and complete Initial Adverse Determinations as indicated.
  • Identify members requiring Care Management Review, evaluate documentation from the Inter-Disciplinary Team and hospital or nursing home discharge planners, and formulate an appropriate plan of care.
  • Document care management and coordination according to company policy and the member’s plan, including monthly telephone and in-person recertification notes as applicable.
  • Develop efficient plans of care, authorize only needed services at appropriate levels, use network providers, and ensure services meet members’ needs.

Desired Qualifications

  • A bachelor's degree in Nursing is preferred.
  • Clinical experience in geriatrics and/or managed long-term care is preferred.
  • Experience using multiple languages may be required based on operational needs.
  • Case Management Certification is preferred.
  • Bilingual speaking and writing skills are preferred.

About the Company

CareSource

Member-first health plan: Marketplace, Medicare, Medicaid

CareSource provides health coverage to more than 2 million members, offering Marketplace plans as well as Medicare and Medicaid products. Its core service is delivering health insurance and related care to individuals and communities through a member-first approach, aiming to improve health and well-being over time. The company operates with a focus on affordable, accessible coverage and care coordination across states, guided by its mission to place people over profits rather than simply selling plans. Key differentiators include a long history (30+ years), a national footprint with 4,500+ employees, and an emphasis on serving members’ needs and languages while promoting equal opportunity employment. The overarching goal is to help members live healthier lives by providing comprehensive coverage and support.

Company size
1,001-5,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Dayton, OH
Founded
1989

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