RN Care Manager - Hybrid (Bengali/Arabic/Chinese Languages Preferred)
Company: Centers Care Solutions
Location: Staten Island
Posted on: March 12, 2025
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Job Description:
Care Solutions' goal is to create the ultimate healthcare
experience that provides our members, their families, healthcare
decision makers, and general caregivers with the guidance and plans
they need for healthy living.Care Solutions is seeking RN Care
ManagerJoin the excitement in support of our MLTC and Medicare
Advantage Plan businesses!Centers Care Solutions (CCS), is a
Managed Care Organization servicing members with Medicare and/or
Medicaid. Our goal is to provide members and all those involved in
their care with the guidance and health plan choices they need for
healthy living. CCS is committed to providing quality, coordinated
health care to some of the most honored and yet still vulnerable
members of our communityThe Care Manager works within a
multidisciplinary team to help identify and manage members who are
in need of additional care or support in their home to improve
their quality of life. Through interventions such as complex case
management and utilization management, the care manager will ensure
coordination of health care services, member education, and
preventative interventions.PRIMARY RESPONSIBILITIES:--- Provides
case management through telephonic assessments, care planning,
implementation, care coordination, monitoring and evaluation to
ensure member receives services and supports required to meet
psychosocial, educational and health care needs--- Develops,
facilitates, and communicates a plan of care in partnership with
the member, his/her significant other, primary caregiver, the
primary and attending physicians, and various other providers
involved in the member's care.--- Initiates utilization review for
preauthorization and post service reviews--- Utilizes knowledge of
community resources and the member's benefit structure--- Interacts
with providers and facilities in a professional, respectful
manner--- Recognizes quality of care issues and escalates the
issues appropriately--- Assists members with the coordination of
services from various settings as appropriate--- Complies with all
CCSs standards for documentation--- Participates in case rounds---
Participates in on call coverage--- Participates in other meetings
as requested--- Participates in quality improvement initiatives---
Other duties as assignedRequired:--- Active and unrestricted NYS RN
license--- Strong written and verbal communication
skillsPreferred:--- Bachelor of Science in Nursing--- CCM
certification--- Knowledge of Milliman or InterQual criteria---
Experience providing care in the home setting--- Experience working
within a managed care environment--- Bengali/Arabic/Chinese
Languages PreferredCare Solutions is committed to leveraging the
diverse backgrounds, perspectives and experiences of our workforce
to create opportunities for our employees and our business. We are
an equal opportunity employer and all qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex, national origin, disability, protected veteran
status or any other characteristic protected by law and will not be
denied employment.
Keywords: Centers Care Solutions, New York , RN Care Manager - Hybrid (Bengali/Arabic/Chinese Languages Preferred), Executive , Staten Island, New York
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