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.

Complex Care Manager

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Manager & Professional
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19164 Requisition #
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Provides in person and or  telephonic Care Management Services to identified high risk members within the community including but not limited to Physician Practices, Neighborhood Care Centers, and members’ homes.  Coordinates and provides care that is safe, timely, effective, efficient and member centered to support EH population health complex care management initiatives.  Engages 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.  Coordinates care as needed with our embedded and field based care managers.

Responsibilities:
  • Assesses and evaluates member’s needs of our most complex members, coordinating care utilizing the most appropriate resources to support member needs.  Includes member and family as appropriate. Engages actively with the member PCP /designee.
  • Engages 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.
  • Assesses the needs of members and aligns them with the appropriate member of the care team ( wellness team, registered dietitian, social worker).
  • Monitors care team performance to insure that members are engaged in a timely fashion and that performance metrics ( Admits/K, ER utilization etc) meet or exceed established thresholds.
  • Provides ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care.
  • Implements and coordinates plan of care and facilitates members goals.
  • Serves as an informal leader of the team with the goal of maintain team performance and high morale.
Qualifications:
  • RN required, current New York State RN license required
  • CCM certified required, but consideration will be given for current enrollees
  • Bachelor’s degree preferred
  • 3 to 5 years of clinical experience required
  • Prior health plan experience highly desirable preferred
  • Excellent verbal and written communication skills required required
  • Computer proficiency required required
  • Able to effectively manage a team of highly complex members required
  • Supports an integrated care model tapping into appropriate resources both internally and external to the organization required

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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