RN Case Manager in Amherst, New York

Company: Fidelis Care New York


Description:

As a mission-driven health plan serving all 62 counties of New York State, Fidelis Care provides quality, affordable health insurance coverage for children and adults of all ages and at all stages of life. Central to our mission is our commitment to be a health care partner, working closely with our members and providers to ensure that everyone receives the care they need, when they need it. From the beginning, Fidelis Care has worked to be part of the social fabric of local communities, impacting people's lives with one of the most basic human rights - access to quality health care and services, close to home.

Position Summary

Works with members and providers to achieve better appointment and care compliance to prevent the incurrence of high cost or poor clinical outcomes; works to target the reduction of case complications through identification of high risk triggers; coordinates care by maintaining clear communication channels with the member and their family, providers and plan staff.

Essential Functions and Responsibilities

Responsibilities

  • Adhere to clinical standards of care through collaboration with providers; practice and adhere to departmental and State guidelines; ensure appropriate outcomes.
  • Communicate with patients, family, and other medical personnel in a timely fashion, as necessary, to facilitate a mutually desired outcome.
  • Collaborate with the Physician Advisor; assess appropriateness and effectiveness of medications to determine a medications use, dosage, and potential side effects on a case by case basis.
  • Create and manage electronic patient files in accordance with departmental and/or regulatory requirements to document patient data including treatments and progress.
  • Attend educational workshops; review professional publications to stay abreast of current trends; establish personal networks and participate in professional societies to maintain professional and technical knowledge.
  • Assist with clarifying and resolving Member complaints; determine the cause of the problem; select and explain the best solution to solve the problem and expedite correction; follow up to ensure resolution.

Educational and Experience Requirements

Work Related Experience:

  • One to three years clinical experience required; assessing treatment needs and making recommendations that impact desired outcomes while maintaining high quality of care.
  • Three to five years related experience preferred.

  • Proficiency in Microsoft Office:
    Excel, Word,  Outlook; Internet.
  • Proficiency in one or more languages other than English.

  • Proficiency in health care claims and service software:
    Facets, CareMark, Trizetto CCA (or similar clinical case management software) preferred.

  • Business Analysis Knowledge:
    Skilled to work in a fast paced environment. Must have strong analytical and problem solving skills.

  • Customer Service:
    Skilled to communicate with all levels of management, internal and external customers.

  • Effective Business Communication:
    Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements.

Education, License, and Certification Requirements

  • BA/BS - Bachelors Degree preferred.
  • NYS Registered Nurse License required.

Time Type:
Full time

Location:
Buffalo Regional Office

Description:As a mission-driven health plan serving all 62 counties of New York State, Fidelis Care provides quality, af...

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