Care Management RN Clinical Lead in Depew, NY

Salary Range: $88,000.00 - $92,000.00 per year

Family Choice of New York is looking for a Care Management RN Clinical Lead

The primary role of the Care Management RN Clinical Lead is to conduct on site assessments and/or desktop case reviews of members who are followed in the care management program.
The Care Management RN Clinical Lead will provide guidance and support to the CSNP Care Management team.
In addition, the Care Management RN Clinical Lead may assist with managing members who are clinically complex.
This position is also responsible for ongoing focus on the achievement of desired clinical outcomes.

This position is a working lead role with time split between clinical accountability and lead responsibilities.
• Maintain regular communication with the member as per Risk Stratification or more frequently based on member needs.
• Within the scope of licensure, continually assess member care needs to assure they are receiving the care ordered in the most effective setting and that the care provided is appropriate.
• Ensure timely completion of HRA per regulations and FC policies.
• Develop individualized care plans for members and ensure all care plans of assigned members within the team are thoroughly reviewed and signed.
• Utilize guidelines provided by IH and FCNY in assessing member needs.
• Assess and document findings in the appropriate care management system per FC policy.
• Complete visits and documentation per company guidelines in a timely manner.
• Each member on site visit note must include subjective data gathered from member, caregiver or other members of the interdisciplinary team as well as an appropriate physical assessment of the member.
• Following a transition of care, ensure that the receiving health care facility/setting understands the member’s needs and have the information they need to provide effective care following the transition.
• Review and discuss the Transition Plan with the patient, his/her family, friends (if appropriate) and professional staff to ensure understanding and agreement.
• Following a transition, collaborate with member, family, and providers to ensure that the discharge plan reflects the right care, at the right time, and in the right setting.
• Provide information and guidance to the patient and/or family for an effective care transition, improved self-management skills, and enhanced patient-healthcare provider communication.
• Assists with the development of frequent transition plan of care to decrease utilization/readmission rate
• Assist and guide with advanced goals of care discussion and MOLST completion.
• Identify the need for social work intervention and/or assist member or families/caregivers with linkage/access to community resources, financial assistance, and/or advanced care planning.
• Coordinate and facilitate the member’s access to services with other health care providers including mental health providers as needed.
• Identify the potential need for additional medical services such as homecare or medical office visits. If appropriate collaborate with the primary care provider or specialists to facilitate appropriate referrals.
• Ensure or arrange that proper HIPAA documentation has been completed when speaking with anyone on behalf of the member.
• May be required to answer member’s calls after hours to provide clinical guidance for urgent issues.
• Complete all Care Management forms and documentation as directed.
• Assist with training and oversight of new team members per management’s request.
• Build rapport with hospitalists, physician consultants, nurses and discharge planners to facilitate identification of high-risk patients, estimate dates of discharge, probable discharge dispositions, etc.
• Assess newly admitted members within company guidelines in a timely manner.
• Facilitate member physician post-hospital visits by providing a list of questions for the physician as needed and following up on diagnostic testing ordered for the member.
• Complete all required care management forms and ensure accurate and thorough documentation in a timely manner. This should occur in the appropriate electronic medical record.
• May include involvement in QA activities of other product lines.
• Attend required meetings as assigned.
• Other duties as assigned.

Clinical Lead Responsibilities:
• Mentoring nurses in the use of sound clinical judgment when managing the member’s care.
• Routine review of care management staff caseload to ensure program performance metrics as per Family Choice guidelines.
• Monitor staff performance and complete performance reviews for Care Management Clinical Staff (RN).
• Collaborate with the Director of ISNP and Clinical Services and Director of CSNP and Care Management in carrying out weekly internal and external ICT meetings.
• Collaborate with the Director of CSNP and Care Management on specific development plans for nurses on the Care Management team.
• Attend required meetings as identified by program management/ as requested.
• May include involvement in QA activities of other product lines.
• Other duties as assigned.

MANAGEMENT RESPONSIBILITIES
• Determine staffing requirements.
• Recruit, hire and onboard/train new staff.
• Supervise direct reporting staff according to overall company policy.
• Set employee goals and objectives.
• Monitor and conduct performance evaluations of staff at the end of the 90 day introductory period, at established development plan dates and at annual anniversary dates for own direct reports.
• Delegate work duties to staff to attain objectives.
• Provide coaching, disciplinary/corrective action as necessary up to termination.
• Develop staff to maximize potential.
• Develop department procedures.
• Apply strategic planning to determine company, department or unit objectives.
• Collaborate with and contribute to the Leadership Team.

EDUCATION:
• RN licensed in New York State
• Bachelor’s degree preferred
• Certified Case Management (CCM) preferred

EXPERIENCE:
• Minimum of 5 years’ experience, preferably in or related to Care Management/Case Management/Discharge Planning.
• Must be able to build and maintain collaborative, cooperative, and productive relationships both over the phone and face to face with all internal and external customers including members and their families, physicians, the health plan, vendors, and other health care providers as well as any other stakeholders in the community.
• Must be skilled in adult clinical nursing and able to make care management assessments of individuals who suffer from multiple co-morbidities on an independent and regular basis both over the phone and face to face in the member’s home.
• Experience in and understanding problems associated with caring for patients with co-morbid chronic conditions.
• Experience in chronic disease management.
• Management/supervision experience preferred.

ABILITIES:
• Effective clinical presentation skills.
• Astute clinical experience and insight into subtle changes in member status with decisiveness in decision making pertinent to needs of members.
• Outstanding written and verbal skills, ability to handle politically sensitive issues.
• Requires outstanding people and communication skills. Must be able to build and maintain collaborative, cooperative, and productive relationships with all internal and external customers including members and their families, physicians, the health plan, and any other stake holders in the community.
• Experience in the development and execution of processes to improve staff work flow, efficiency and effectiveness.
• Ability to effectively delegate and maintain oversight while also being an active contributor to final work product.

REQUIREMENTS:
• CPR certification
• Valid NYS Driver’s License and active automobile insurance to meet company requirements
• Transportation
• Occasionally lift light weight (up to 10 lbs.)

Pay: $88,000.00 - $92,000.00 per year

Benefits: 401(k), 401(k) matching, Dental insurance, Employee assistance program, Flexible spending account, Health insurance, Life insurance, Paid time off

Please apply with resume via Quick Apply