The Registered Nurse Case Manager is responsible for assisting Staten Island Health Plan (SIHP) HARP members identified at risk for recidivism, discontinuous care, or as members of special needs populations who present with complex needs for coordination of their behavioral health service with other aspects of their care. The HARP Case Manager is responsible for assisting these assigned members to care at all levels of the continuum, and for providing any and all required field visits, discharge coordination, referrals to care, plan of care development, and care coordination as needed. The Case Manager executes these responsibilities consistent with the applicable SIHP’s policies and procedures. A HARP Case Manager represents the organization to providers, member groups and families, and participates in the overall administration of clinical operations as warranted.
The HARP Case Manager is expected to bring a level of clinical leadership to the care management department. These case managers are specifically chosen based upon a targeted area of practice, supported by education, training and experience, with expertise in the delivery of behavioral health care to a given population. In addition, a case manager may serve as the care management lead for other members of his/her team. Case managers are responsible to meet with members in their homes, hospitals and other outpatient settings.
ESSENTIAL DUTIES & RESPONSIBILITIES
- Assumes responsibility for a designated client case load.
- Conducts clinical assessments, develops plan and appropriate interventions, and care coordination (or oversight and supervision) for all assigned members receiving behavioral health services.
- Develops specific outreach plans for assigned members who do not maintain regular contact with their behavioral/physical health provider as recommended contributing to frequent crises, readmissions, loss to care, and interfering with maximum benefit from available care.
- Maintains an understanding of medical and behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services.
- Supervises collection of information regarding the delivery and outcomes of services to members, and sues that information to recommend modifications to plan policies and procedures which improve the delivery of services to members.
- Provides education related to chronic medical conditions.
- Provides member, providers, and other stakeholders with accurate information concerning behavioral health care benefits and coverage.
- Works with members and providers to customize services to best meet member’s needs within the scope of SIHP’S obligations to its members.
- Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented.
- Receives and responds to complex and crisis calls.
- Facilitates linkages for members and families between primary care and behavioral health providers and other social services or provider agencies as needed to develop and coordinate service plans.
- Collaborates with providers and health homes in order to obtain initial assessments, treatment planning and aftercare planning for members.
- Encourages coordination of care with primary care physician and other service providers integral to the member’s life.
- Monitors and evaluates effectiveness and outcome of treatment and service plans and recommends modifications as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care.
- Utilizes supervision with medical director and clinical manager regularly and maintains close relationship with clinical leadership team.
- Participates in CQI activities and provider training.
- Possesses excellent clinical skills with sophisticated understanding of the overall needs of individual members assigned.
- Demonstrates knowledge of clinical treatment, case management, and community resources.
- Proficiency in operating computer software.
Associates degree required. Bachelor’s preferred.
Additional Educational requirements:
- Registered Nurse with a current New York State license is required.
- Certification in substance use disorders preferred.
- A minimum of three (3) years clinical experience is required.
- 1-2 years of medical-surgical nursing strongly preferred.
- Experience in managed care strongly preferred.
- Experience with chronic condition management, particularly diabetes and heart disease is required.
- Certification in substance use disorders helpful. Behavioral health experience preferred.
- Case management experience and CCM certification preferred.
SKILLS & ABILITIES
- Ability to provide case management for complicated members with multiple comorbidities and chronic diseases.
- Demonstrated ability to work with diverse population.
- Demonstrates excellent clinical, written and oral communication skills, knowledge of clinical treatment, case management, and community resources.
- Ability to communicate effectively with members with varying levels of education, health literacy and understanding.
- Demonstrated ability to interact with provider, members to positively impact the quality of patient care.
- Proven customer service skills.
- Working knowledge of health, social service and funding resources, including community agencies and alternate care delivery systems.
- Access to reliable transportation, including a valid driver’s license and driving record showing no restrictions that would impede ability to travel by car required.
- Flexibility to travel to a variety of sites across SIHP service area required. At times may include evenings and/or weekends.
- Spanish speaking or bilingual preferred.
Staten Island Performing Provider System offers a competitive salary and full benefits.
Please send a resume to Ashley Restaino at email@example.com.