Requirements
- Bachelor Degree of Science in Nursing.
- Master's Degree preferred.
- New York Licensure as a Registered Nurse with current registration.
- Patient Review Instrument Assessor Certification.
- CCM certification a plus.
- BCLS.
- Minimum of 5 years working as a Case Manager.
- 5 yrs. Med/Surg experience required, Critical Care and Disease Management experience preferred.
- Knowledge of Case Management Scope of Practice and operate within guidelines.
- Knowledge of Nursing principles, techniques, practices and procedures.
- Knowledge of updated regulatory compliance information related to Managed Care, DOH and CMS as needed to perform the job.
- Knowledge of Allscript Care Management, utilization management and Milliman Care Guidelines.
- Problem solving abilities: analytical skills, problem identification, identifying alternative courses of action. Must identify changes in patients’ conditions or problems related to treatment and recommend/implement therapeutic course(s) of action.
- Initiative/ Creativity: Slightly varied functions; some judgment required in selecting applicable rules or procedures; precedent is clearly defined. Substantial independence is permitted; work may involve the supervision, development or modification of procedures or projects under broad supervision.
- Good oral and written communication, patient interaction and human relations skills.
- Basic computer skills, advanced training preferred.
- Effective leadership and communication skills required.
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