Urgent! Care Manager, RN - Restricted Recipient Program Job Opening In Remote – Now Hiring Healthfirst
**Duties//Responsibilities of the Restricted Recipient Program:**
+ **Oversees the care management of members in the NYS RRP who require tightly managed access to medical services due to their historic misuse//abuse of Medicaid program resources.**
+ **Conducts medical reviews of member usage patterns analyzing for fraud, waste or abuse trends to determine whether restrictions should be applied, remain or lifted as a result.**
+ **Participates in RRP Committee meetings; presenting member updates as needed.**
+ **Provides care management to high risk//cost and//or RRP Committee referred members, to improve health outcomes, coordination of benefits and SDOH, and//or members referred by families or providers.**
+ **Attends Clinical Rounds with medical providers and interdisciplinary team.**
+ **Provides programmatic case management to complex care//rising risk members including those who are HIV+ and viral load unsuppressed.**
+ **Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.**
+ **Conducts assessments to identify barriers and opportunities for intervention.**
+ **Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals.**
+ **Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.**
+ **Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly.**
+ **Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes.**
+ **Assists in identifying opportunities for alternative care options based on member needs and assessments.**
+ **Evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan.**
+ **Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.**
+ **Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as** **appropriate.**
+ **Occasional overtime as necessary.**
+ **Additional duties as assigned.** **Minimum Qualifications:**
+ **NYS RN** **Preferred Qualifications:**
+ **Strong interpersonal and assessment 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.**
+ **Fluency in Spanish, Korean, Mandarin, or Cantonese.**
+ **Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors.**
+ **Knowledge of InterQual and LOCADTR.**
+ **Experience managing member information in a shared network environment using paperless database modules and archival systems.**
+ **Experience and knowledge of the relevant product line**
+ **Relevant work experience preferably as a Care Manager**
+ **Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment**
+ **Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems**
+ **Experience usingMicrosoft Excel with the ability to edit, search, sort//filter and other Microsoft and PHI systems**
WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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Unlock Your Care Manager Potential: Insight & Career Growth Guide
Real-time Care Manager Jobs Trends in Remote, United States (Graphical Representation)
Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for Care Manager in Remote, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 491188 jobs in United States and 1275 jobs in Remote. This comprehensive analysis highlights market share and opportunities for professionals in Care Manager roles. These dynamic trends provide a better understanding of the job market landscape in these regions.
Great news! Healthfirst is currently hiring and seeking a Care Manager, RN Restricted Recipient Program to join their team. Feel free to download the job details.
Wait no longer! Are you also interested in exploring similar jobs? Search now: Care Manager, RN Restricted Recipient Program Jobs Remote.
An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at Healthfirst adheres to the cultural norms as outlined by Expertini.
The fundamental ethical values are:The average salary range for a Care Manager, RN Restricted Recipient Program Jobs United States varies, but the pay scale is rated "Standard" in Remote. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.
Key qualifications for Care Manager, RN Restricted Recipient Program typically include Other General and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.
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Here are some tips to help you prepare for and ace your job interview:
Before the Interview:To prepare for your Care Manager, RN Restricted Recipient Program interview at Healthfirst, research the company, understand the job requirements, and practice common interview questions.
Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the Healthfirst's products or services and be prepared to discuss how you can contribute to their success.
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