Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.


To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Care Manager, Complex & Disease Management

📁
Manager & Professional
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ConnectiCare
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Summary of Job:

Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members’ health care needs, identifying gaps in care and needed support, administering/coordinating implementation of interventions. Support and enable members to manage their physical, environmental and psycho-social concerns, understand and appropriately utilize their health plan benefits and remain safe and independent in their home or current living environment in collaboration with health care providers. Provide Care Management services to identified high risk members within the community, including but not limited to Physician Practices, Retail Centers/Neighborhood Care Centers, and members’ homes.  Coordinate and provide care that is safe, timely, effective, efficient and member-centered to support population health, transitions of care, and complex care management initiatives. Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate and timely utilization of services across the continuum of care. Assist the entire Care Management interdisciplinary team in managing members with Care Management needs.

Requirements:

  • Assess and evaluate the needs of our most complex members, acting as the clinical coordinator collaborating with members, caregivers, providers, multi-disciplinary team, and health care and community resources through a variety of assessments to identify areas of (medical, financial, environmental, health insurance benefit, psycho-social, caregiving) concerns and potential gaps in care utilizing the most appropriate resources to support members’ needs. 
  • Identify appropriate goals, strategies and interventions that may include referrals, health education, activation of community-based resources, life planning, or program/agency referrals based on areas of concern. 
  • Develop, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high quality, cost effective continuum of care with the member, caregiver, provider(s) and multidisciplinary team. Include member and family as appropriate. 
  • Engage actively with the member PCP / designee.
  • Engage with the member in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes for member.
  • Work collaboratively with all stake holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences when appropriate. 
  • Assess the needs of members and align them with the appropriate member of the care team (wellness team, registered dietitian, social worker, community health workers).
  • Act as the member’s advocate and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies. 
  • Engage with the member in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes for member.
  • Work collaboratively with all stake holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences when appropriate. 
  • Assess the needs of members and align them with the appropriate member of the care team (wellness team, registered dietitian, social worker, community health workers).
  • Act as the member’s advocate and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies. 
  • Ensure that all Care Management processes and reporting are compliant with all applicable federal and state regulations, and NCQA and company standards.
  • Participate in delegation collaboration activities, as required.
  • Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making care management recommendations. 
  • Enter and maintain documentation in the Electronic Medical Records System (EMR), meeting defined timeframes and performance standards. 
  • Maintain an understanding of Care Management principles, program objectives and design, implementation, management, monitoring, and reporting. 
  • Actively participate on assigned committees. 
  • Attend and complete all department-mandated training as well as satisfy educational in-service requirements.
  • Perform other related projects and duties as assigned.
  • Provide ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care.
  • Develop, implement and coordinate plan of care and facilitate members’ goals.
  • Coordinate interdisciplinary team tasks and activities, with the goal of maintaining team performance and high morale. 
     

 

 

Qualifications:

  • Bachelor’s degree. RN required, with current active RN license
  • CCM certification preferred; Certification in utilization or care management preferred
  • 4 – 6 years of clinical experience required
  • Organization/prioritization ability; and the ability to effectively manage a caseload of highly complex members
  • Support an integrated care model tapping into appropriate resources both internally and external to the organization
  • Experience in case management/care coordination, managed care, and/or utilization management preferred
  • Strong communication skills (verbal, written, presentation, interpersonal). 
  • Trained in the use of Motivational Interviewing techniques preferred
  • Experience working in medical facility or practice and/or with electronic medical records preferred
  • Computer proficiency: MS Office (Word, Excel, Powerpoint, Outlook); mobile technology (wireless phone/laptop, etc.)                                                          System user experience in a highly automated environment  
  • Bilingual ability (verbal, written) preferred
  • Strong cross-group collaboration, teamwork, problem solving, and decision-making skills
  • Ability to work a flexible schedule to meet member and/or caregiver and departmental scheduling needs

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action 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.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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