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About the Role

The Case Manager will provide transition of care support to Independent Health members following discharge from a Catholic Health facility. The role involves engaging members post-discharge, coordinating care, addressing barriers, and promoting positive health outcomes in collaboration with Catholic Health's interdisciplinary team.

Responsibilities

• Helping members achieve well-being and avoid hospital admissions or readmissions through quality improvement functions.
• Performing telephonic outreach to members, physicians, or other care givers to develop a plan of care.
• Optimizing member wellness and functional capability using a member-centric, collaborative process and available resources.
• Applying case management principles including assessment, planning, facilitation, care coordination, evaluation, and advocacy.
• Adhering to regulatory and compliance requirements, productivity and quality metrics, and providing exceptional customer service.
• Assessing the patient’s broad spectrum of immediate and long-term needs through evaluation of social and medical history.
• Developing a plan of care based on providers' assessments and patients' needs.
• Providing ongoing assessment and documentation to monitor member response to the plan of care and revising as needed.
• Measuring and reporting outcomes that demonstrate the efficacy, quality, and cost-effectiveness of case management interventions.
• Conducting comprehensive assessments of health and psychosocial needs, including health literacy, cultural, clinical, and laboratory data.
• Serving as the Plan Foster Care Liaison, responsible for clinical management and care coordination with OCFS, LDSS, and VFCAs for shared Medicaid children in foster care.
• Facilitating communication and coordination between healthcare team members and ensuring safe transition of care.
• Identifying cases that would benefit from alternative care through assessment and evaluation of patient needs and available resources.
• Applying appropriate medical policies to evaluate the medical necessity, appropriateness, and efficient use of healthcare services.
• Identifying and reviewing high-risk cases to ensure members are transitioned to appropriate care.
• Documenting the patient’s plan of care in a timely manner.
• Employing evidence-based guidelines and self-management resources to maximize member health, wellness, safety, adaptation, and self-care.
• Understanding and applying case management concepts such as roles, philosophies, principles, liability, and confidentiality.
• Utilizing adherence guidelines, standardized tools, and proven processes to improve outcomes and support health behavior change.
• Ensuring compliance with regulatory standards, local, state, and federal laws, and employer policies.
• Actively participating in project teams and medical management initiatives.
• Assisting in the orientation of associates.

Requirements

• Registered Nurse (RN) with active, current, unrestricted NYS license, licensed master social worker (LMSW), master’s in social work (MSW), or licensed dietician with case management experience required.
• Case Management Certification (CCM) required. Candidates without CCM certification must obtain it within two (2) years of employment.
• Two (2) years of case management or clinical experience in acute medical/surgical/critical care or ambulatory setting required.
• Proficient computer and Windows skills required, including MS Office.
• Previous clinical experience in a managed care setting as a case/care manager preferred.
• Clinical knowledge of the health and social needs of the population served.
• Ability to identify barriers to a successful case management path.
• Excellent critical thinking and time management skills.
• Excellent written, verbal, and interpersonal communication skills with ability to provide exceptional customer service.
• Telephonic interviewing of members; motivational interviewing skills a plus.
• Transferable knowledge, skill, and ability to complete job duties independently and proficiently.
• Flexibility in work schedules and assignments required.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Skills

• Case Management
• MS Office
• Telephonic interviewing
• Motivational interviewing
• Critical thinking
• Time management
• Written communication
• Verbal communication
• Interpersonal communication
• Customer service

Location

• Downtown facility (onsite approximately 50%)
• Remote (remainder of work)

Work Type

• Hybrid

Experience Level

• 2 years of case management or clinical experience

Education Level

• Registered Nurse (RN) with active, current, unrestricted NYS license
• Licensed Master Social Worker (LMSW)
• Master's in Social Work (MSW)
• Licensed Dietician

Salary/Compensations

• $33.50 - $38.00 hourly

Benefits

• Scorecard incentive
• Full range of benefits
• Generous paid time off

About the Company

• We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

Equal Opportunity

• As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.