Clinical Care Manager, RN
OverviewOversees and directs clinical utilization, authorization, and care management for field staff and/or managed care organizations to ensure effective utilization and care management as defined by inter professional best practices.
Ensures clear and appropriate visit utilization using evidence-based practices to provide positive clinical outcomes and efficient use of resources.
Identifies and addresses inter-professional performance issues related to utilization management among staff and provides individualized performance evaluation assessments to clinical leadership and staff.
Utilizes evidence based practices to care manage individuals to prevent hospitalization occurrences.
Manages relationships with individuals in order to prevent untoward outcomes.
Manages clinical and financial risk of value based contracts.
ResponsibilitiesPartial remote schedule (1 - 2 day/week) after 6 month probationary period.
Authorizes and oversees visits per episode for the optimal utilization that results in the best possible clinical outcomesand efficient use of resource Works directly with the patient, via various forms of communication, texting, virtual visits, and telephone, to achievepatient stated goals Analyzes utilization to ensure visits are made according to episode utilization guidelines and clinical outcomes bestpractices.
Develops/revises utilization policies and practices based on analysis of past practices to improve utilization Applies clinical experience and judgment to the utilization management/care management activities Addresses payor authorizations/reauthorizations within established time frames which includes, but is not limited to,reviewing clinical reports of providers for relevant patient data, communicating patient condition to payor case managerin a manner that is focused and reflects knowledge/understanding of patient condition/progress, and negotiatingauthorizations consistent with clinical data Ensures appropriate utilization of home health care and other resources for optimal, cost effective care and services byreviewing clinical reports, DME/supply requisitions, and visit threshold reports.
Establishes on-going dialogue withpayor case managers and provider disciplines (e.
g.
, nurses, physical therapist, occupational therapist, speech therapy,social worker) Directs field staff to take actions that address issues and improve performance, including changing plans of care andnotifies payor case manager of significant changes in patient condition.
Evaluates performance and reportsassessments to clinical management and works with them to set accountability mechanisms and long-term correctionstandards CA2019QualificationsLicenses and Certifications:
License and current registration to practice as a Registered Professional Nurse in NYS requiredPopulation Care Coordination certification preferredCare Management, Case Management, OASIS or other applicable certification preferred Education:
Associate's Degree in nursing requiredBachelor's Degree in nursing preferredWork
Experience:
Minimum two years of experience as a registered nurse requiredCare management and/or managed care experience preferredProficiency in Microsoft Office applications requiredDemonstrated analytical skills required Compensation Range From and To:
$90,700.
00 - $113,400.
00 Annual Recommended Skills Analytical Assessments Care Coordination Case Management Certified Nurse Practitioner Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
Ensures clear and appropriate visit utilization using evidence-based practices to provide positive clinical outcomes and efficient use of resources.
Identifies and addresses inter-professional performance issues related to utilization management among staff and provides individualized performance evaluation assessments to clinical leadership and staff.
Utilizes evidence based practices to care manage individuals to prevent hospitalization occurrences.
Manages relationships with individuals in order to prevent untoward outcomes.
Manages clinical and financial risk of value based contracts.
ResponsibilitiesPartial remote schedule (1 - 2 day/week) after 6 month probationary period.
Authorizes and oversees visits per episode for the optimal utilization that results in the best possible clinical outcomesand efficient use of resource Works directly with the patient, via various forms of communication, texting, virtual visits, and telephone, to achievepatient stated goals Analyzes utilization to ensure visits are made according to episode utilization guidelines and clinical outcomes bestpractices.
Develops/revises utilization policies and practices based on analysis of past practices to improve utilization Applies clinical experience and judgment to the utilization management/care management activities Addresses payor authorizations/reauthorizations within established time frames which includes, but is not limited to,reviewing clinical reports of providers for relevant patient data, communicating patient condition to payor case managerin a manner that is focused and reflects knowledge/understanding of patient condition/progress, and negotiatingauthorizations consistent with clinical data Ensures appropriate utilization of home health care and other resources for optimal, cost effective care and services byreviewing clinical reports, DME/supply requisitions, and visit threshold reports.
Establishes on-going dialogue withpayor case managers and provider disciplines (e.
g.
, nurses, physical therapist, occupational therapist, speech therapy,social worker) Directs field staff to take actions that address issues and improve performance, including changing plans of care andnotifies payor case manager of significant changes in patient condition.
Evaluates performance and reportsassessments to clinical management and works with them to set accountability mechanisms and long-term correctionstandards CA2019QualificationsLicenses and Certifications:
License and current registration to practice as a Registered Professional Nurse in NYS requiredPopulation Care Coordination certification preferredCare Management, Case Management, OASIS or other applicable certification preferred Education:
Associate's Degree in nursing requiredBachelor's Degree in nursing preferredWork
Experience:
Minimum two years of experience as a registered nurse requiredCare management and/or managed care experience preferredProficiency in Microsoft Office applications requiredDemonstrated analytical skills required Compensation Range From and To:
$90,700.
00 - $113,400.
00 Annual Recommended Skills Analytical Assessments Care Coordination Case Management Certified Nurse Practitioner Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
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