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Respiratory Complex Care Manager - 100% Remote
Healthfirst • Remote • Posted 24 days ago
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Remote • Full-time • Mid Level
Job Highlights
Using AI ⚡ to summarize the original job post
The Respiratory Complex Care Manager at Healthfirst is responsible for advocating, informing, and educating beneficiaries on services, self-management techniques, and health benefits. This role involves conducting assessments to identify barriers and opportunities for intervention, developing interdisciplinary care plans, generating referrals to providers and community-based resources, and collaborating with a multi-disciplinary health care team to ensure care plan goals are achieved. The position requires a NY Registered Nurses license and offers the opportunity to work remotely.
Responsibilities
- Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
- Conducts assessments to identify barriers and opportunities for intervention, including addressing the social determinants of health
- Develops interdisciplinary care plans that align with the provider's treatment plans and recommends interventions that align with proposed goals.
- Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
- Collaborates with provider doctors, social workers, discharge planners, and community-based service providers to coordinate care accordingly.
- Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals are achieved and maximize member outcomes.
- Assists in identifying opportunities for alternative care options based on member needs and assessments.
- Evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan.
- Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
- Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.
- Occasional overtime as necessary.
- Additional duties as assigned.
Qualifications
Required
- NY Registered Nurses license
- LCSW, LMSW
Preferred
- Experience with care management and/or chronic disease management
- Strong interpersonal and assessment skills
- Fluency in Spanish, Korean, Mandarin, or Cantonese
- Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors
- Knowledge of InterQual and LOCADTR
- Experience managing member information in a shared network environment using paperless database modules and archival systems
- Experience and knowledge of the relevant product line
- Relevant work experience preferably as a Care Manager
- Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
- Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
- Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems
About Healthfirst
Healthfirst is a leading health insurance provider in New York, offering a variety of affordable health plans for individuals and families. They specialize in comprehensive health insurance, Medicare Advantage plans, and long-term care coverage. With a strong commitment to accessible healthcare, Healthfirst also provides resources and support for COVID-19 testing and vaccination.
Full Job Description
Duties/Responsibilities:
Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
Conducts assessments to identify barriers and opportunities for intervention, including addressing the social determinants of health
Develops interdisciplinary care plans that align with the provider's treatment plans and recommends interventions that align with proposed goals.
Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
Collaborates with provider doctors, social workers, discharge planners, and community-based service providers to coordinate care accordingly.
Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals are achieved and maximize member outcomes.
Assists in identifying opportunities for alternative care options based on member needs and assessments.
Evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan.
Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.
Occasional overtime as necessary.
Additional duties as assigned.
Minimum Qualifications
NY Registered Nurses license
LCSW, LMSW
**Preferred Qualifications**
Experience with care management and/or chronic disease management
+ Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.
+ Fluency in Spanish, Korean, Mandarin, or Cantonese.
+ Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors.
+ Knowledge of InterQual and LOCADTR.
+ Experience managing member information in a shared network environment using paperless database modules and archival systems.
+ Experience and knowledge of the relevant product line
+ Relevant work experience preferably as a Care Manager
+ Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
+ Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
+ Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
Conducts assessments to identify barriers and opportunities for intervention, including addressing the social determinants of health
Develops interdisciplinary care plans that align with the provider's treatment plans and recommends interventions that align with proposed goals.
Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
Collaborates with provider doctors, social workers, discharge planners, and community-based service providers to coordinate care accordingly.
Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals are achieved and maximize member outcomes.
Assists in identifying opportunities for alternative care options based on member needs and assessments.
Evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan.
Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.
Occasional overtime as necessary.
Additional duties as assigned.
Minimum Qualifications
NY Registered Nurses license
LCSW, LMSW
**Preferred Qualifications**
Experience with care management and/or chronic disease management
+ Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.
+ Fluency in Spanish, Korean, Mandarin, or Cantonese.
+ Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors.
+ Knowledge of InterQual and LOCADTR.
+ Experience managing member information in a shared network environment using paperless database modules and archival systems.
+ Experience and knowledge of the relevant product line
+ Relevant work experience preferably as a Care Manager
+ Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
+ Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
+ Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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