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 - Obstetrics and Gynecology

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Manager & Professional
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1909S Requisition #
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Support EmblemHealth population health complex care management initiatives by providing care management services engaging with complex individuals enrolled in care management programs.  Assess plans, implement, coordinate, monitor, and evaluate all options and services with the goal of optimizing the patients’ health status.  Integrate evidence-based clinical guidelines, preventive guidelines, and protocols, in the development on individualize care plans that are patient-centric, promoting quality and efficiency in the delivery of health care.  Coordinate care across settings and helps patients/families understand health care options.

Responsibilities:
  • Assess and evaluate needs of our complex members, coordinating care utilizing the most appropriate resources to support member needs.  This includes member and family as appropriate. 
  • Engage actively with the member PCP /designee.
  • Responsible for developing a comprehensive individualized plan of care. Continually monitors patient/family response to plan of care and revises the care plan as indicated.
  • Implement systems of care that facilitate close monitoring of high-risk patients to prevent and/or intervene early during acute exacerbations.
  • Coordinate patient care through ongoing collaboration with PCP, patient/family, community and other members of the health care team. Takes the lead in ensuring the continuity of care which extends beyond the practice boundaries. Serve as liaison to acute care hospitals, specialist and post-acute care services.
  • Provide follow-up with patient/family when patient transitions from one setting to another. Completes timely post-hospital follow-up: Medication reconciliation, PCP or specialist follow-up appointment, asses symptoms, teach warning signs, review discharge instructions, coordination of care and problem solve barriers.
  • Maintain required documentation for all care management activities.
Qualifications:
  • Bachelor’s degree from an accredited college or university
  • 4 to 6 years of clinical experience
  • Current New York State RN license
  • Additional years of relevant experience may be considered in lieu of 4 year college degree
  • CCM certified required, but consideration will be given for current enrollees (candidates actively seeking certification)
  • Prior health plan experience highly desirable
  • Excellent verbal and written communication skills required
  • Computer proficiency required
  • Serve as an informal leader of the care team demonstrating excellent team work and collaboration skills. 
  • Exhibit informal leadership strengths and team building skills  
  • Support an integrated care model tapping into appropriate resources both internally and external to the organization
  • Highly motivated and able to work in an environment that embraces innovation
  • Highly collaborative, working across functional areas to improve member outcomes.
  • Excellent interpersonal and communication (verbal and written) skills 
  • Able to flex their approach to meet the unique member needs using very strong clinical judgment

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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