Job Description

GLIN IPA seeks a dedicated and proactive Care Manager Registered Nurse (RN) to join our multidisciplinary healthcare team. In this role, the Care Manager RN will provide patient-centered coaching and care coordination in a primary care and telephonic setting, ensuring seamless navigation for patients with complex needs. The Care Manager RN will identify at-risk patients and collaborate with providers to develop and implement processes for preventative care, transitions of care, and chronic disease management. Using defined protocols and clinical expertise, the Care Manager RN will support patients following clinical events, address nursing care needs, and promote improved health outcomes. This role is essential in coordinating patient care, attributed to value-based contracts, and working closely with primary care providers and medical home teams to deliver high-quality, cost-effective care.

Duties and Responsibilities (including but not limited to)

• Evaluate patients for care management services, determine the appropriate level of care coordination management for the patient
• Complete a comprehensive assessment to identify patient risk and develop a care plan utilizing clinical expertise and judgment to evaluate the need for alternative services as needed
• Work collaboratively with physicians and in-house resources, including pharmacists, registered dieticians, social workers, and other disciplines, to create a person-centered care plan with measurable SMART goals
• Monitor and update the care plan to include progress toward achieving established goals and self-management activities
• Interact with patient, family and providers, and multidisciplinary care team to assess the options of care, including use of benefits and community resources to update the care plan. Utilize developed systems, processes, and initiatives to engage patients in relevant case management activities necessary to promote wellness and care at the right place and time.
• Work collaboratively with physicians and in-house resources, including pharmacists, registered dieticians, social workers, and other disciplines, to support patient adherence to medical plan of care.
• Supervise and act as a resource for non-clinical staff (i.e., care coordinators and social workers).
• Verify that appropriate home care, hospice care, and other ancillary services (DME, infusion services, etc.) are in place and are being delivered as directed by the care team
• Coordinate necessary referrals and authorizations within care management areas
• Facilitate the information flow between the hospital, long-term care, specialists and home health representatives and the care team
• Use available data and work with physicians and office staff to help identify high-risk, high-need, and potentially high-cost patients
• Coordinate care and communicate with multiple providers, internal and external to the practice.
• Identify and utilize cultural and community resources and align with the patient’s cultural preferences as much as possible
• Ensure that members are screened for behavioral health issues, such as depression and substance abuse, and that they are receiving the necessary interventions and support.
• Facilitate any necessary follow-up behavioral health needs with local behavioral health providers.
• Attend required training and collaboration sessions [i.e., learning sessions, care management meetings, and practice team meetings] as scheduled.
• Provide and facilitate open communication with physicians and office staff regarding patient status.
• Obtain records from other physicians/labs/diagnostic centers as requested by the physicians and as needed for care coordination efforts.
• Build collaborative relationships with the internal GLIN IPA population health team, participating providers, and community resources.
• Other job-related duties as assigned.

Qualifications or Education, Training, and Experience

• New York State Licensed RN
• Bachelor’s degree in nursing preferred; Associate degree in nursing is minimum requirement.
• 2-3 years of experience in acute inpatient care, rehabilitation, sub-acute care, skilled nursing facilities, home care, ambulatory care management, or managed health plans.
• Preferred: Certified Case Management (CCM) certification
• Preferred: Care/Case Management experience

Working knowledge of the following required:

• Principles of utilization management; care management principles; basic knowledge of health plan contracts and benefit eligibility requirements; Hospital structures, Managed Care and payment systems
• Timely and accurate documentation of day-to-day activities in designated technology platform
• Adaptable to new technologies and software
• Proficiency in EMR system(s), Outlook and data entry experience preferred
• Basic PC skills (MS Word/Outlook/PPT/Excel)

We offer an outstanding benefits package including health, dental, 401K, vacation, PTO, and a great working environment.

Pay range $80,000 to $93,000 annually

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range and determined by considering factors including, but not limited to, market data, education, experience, qualifications, and expertise of the individual, as well as internal equity considerations.

Equal Employment

Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and leads New York in provider and patient satisfaction. Great Lakes Integrated Network IPA (GLIN IPA) values diversity, inclusion, and equity as matters of fairness and effectiveness. We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feel welcomed and engaged.

Great Lakes Integrated Network is an Equal Opportunity Employer

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