REMOTE Clinical Care Manager (RN) **Must be licensed in NY state and commutable to NYC** Job Overview: We are seeking dedicated Registered Nurses (RNs) to join our team, specializing in Medicaid care management. Our mission is to deliver personalized, evidence-based care that empowers patients to manage their health safely within their homes and communities. As a Clinical Care Manager, you will play a crucial role in coordinating healthcare benefits and services, ensuring high-quality, cost-effective care for a diverse patient population. Key Responsibilities:
- Coordinate and oversee benefits and services for all members on your caseload.
- Complete care management and disease-specific assessments.
- Conduct timely telephonic care management calls based on risk levels.
- Resolve complex issues and member complaints related to service delivery.
- Provide health education to members and caregivers.
- Assess Social Determinants of Health (SDoH) and coordinate care to reduce barriers.
- Identify and address member safety issues, referring to appropriate resources when necessary.
- Advocate for members/caregivers to optimize their quality of life.
- Promote adherence to physician treatment plans through education, coaching, and support.
- Increase utilization of primary care, specialty care, preventive health, and guideline-based treatments.
- Participate in interdisciplinary team (IDT) meetings, providing input on customer service-related activities.
- Protect the confidentiality of member information and ensure compliance with company policies and regulations.
Qualifications:
- Associate degree in nursing or a bachelor's degree in nursing required.
- Minimum two years of experience as a registered nurse.
- Active and current license as a Registered Professional Nurse in the State of New York.
- Population Care Coordination Certification preferred.
- Care Management, Case Management, OASIS, or other application certification preferred.
Preferred Background:
- Experience with patients diagnosed with HIV, or familiarity with HIV care.
- Experience in care management, especially within Medicaid.
- Experience in transgender care or mainstream/traditional Medicaid.
- Spanish bilingual skills are highly desirable.
Caseload:
- Manage a caseload of approximately 250 members, with a CMSC partner. Outreach calls will be rotated monthly, with flexibility for clinical needs.
Work Environment:
- Primarily remote, with potential in-office requirements up to 6 times a year (subject to increase). Flexibility is expected.
Join us in making a meaningful impact in the lives of our patients, helping them navigate their healthcare journey with confidence and support. Apply today to become a part of our dedicated team! #medixeast