Enrollment Specialist/nurse Rn
AMERIGROUP Corporation (New York City, New York)

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Description: JOB SUMMARY: The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to members health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:

1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the members needs and the referral sources requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. May be required to conduct field visits.

9. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

10. Acts as an advocate for an individuals health care needs.

11. Reviews benefit systems and cost benefit analysis.

12. Evaluates the quality of necessary medical services.

13. Utilizes criteria for authorizing appropriate clinical services.

14. Identifies members that would benefit from an alternative level of care.

15. Acquires data and evaluates necessary health services for cost containment.

16. Documents effectiveness of case management services.

17. Identifies the need for assistive devices/adaptive equipment needed for members.

18. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

19. Requests direction from appropriate supervisor(s) on complex issues.

20. Utilizes leadership skills for non-clinical team members.

21. Collaboratively works with other departments.

22. Participates in Quality Improvement processes.

23. Serves on internal and external committees.

24. Maintains member confidentiality.

25. Other duties as requested or assigned. Qualifications: EDUCATION AND EXPERIENCE:
Education
Required:
- RN required with four years experience in health care, case management, discharge planning or behavioral health.
- Current State RN license to practice Nursing.
- Florida Long Term Care Community Diversion Waiver Project requirements: Must attend and complete four hours of in-service training annually and the Abuse and Neglect Exploitation training approved by the Department of Elder Affairs.
Preferred:
- Bachelors or Masters Degree
Years and Type of Experience
Required:

Preferred:
- Experience working on the community level and with community agencies preferred.
Specific Technical Skills
Required:
Preferred:

Certifications or Licensure
Required:
- Current State RN license to practice Nursing.
- Must possess a valid drivers license and access to a motor vehicle.
Preferred:
- Certified case managers preferred.
Other
Required:
- Computer literate.
- Excellent verbal and written communications skills.
- Strong decision making skills.
- Ability to provide services in an environment that involves multiple health care systems.
- Ability to interact with all relevant components of the health care system.
- Ability to provide services that deal with the individuals broad spectrum of needs.
- Self-starter with ability to handle multiple projects at one time.
- Appreciation of cultural diversity and sensitivity towards target population.
- Bilingual a plus.
Preferred:


PHYSICAL REQUIREMENTS:
- Must be able to operate a computer.
- Must be able to operate (and communicate via) a telephone.
- Must be able to sit for long periods of time Salary/Benefits: Salary commensurate with experience AMERIGROUP Associates help make a difference in the hundreds of lives they touch every day. We understand that many of our members are moms and kids who depend on us to help them get the health care their family needs. If you share our commitment to improving people's lives, AMERIGROUP may have a place for you. AMERIGROUP Corporation is committed to associate career development and growth, providing opportunities in a culturally diverse, energetic environment. We take pride in offering extensive training programs, competitive compensation, incentives and excellent benefits including:
* Relocation Assistance
* Paid Accumulated Leave
* Holidays
* Medical Insurance
* Dental Insurance
* Life Insurance
* Short-Term Disability
* Long-Term Disability
* 401(k)
* Employee Stock Purchase Plan
* Flexible Spending Accounts
* Employee Assistance Program
* Company Sponsored Training
* Departmental Incentives
* Continued Career Growth and Development Opportunities Job Location: New York, NY Job Number: 8707 Company URL: http://www.amerigroup.jobs Company Profile: AMERIGROUP Corporation (NYSE: AGP), headquartered in Virginia Beach, VA, is a multi-state managed health care company focused on serving people who receive health care benefits through state-sponsored programs. From Medicaid, Temporary Assistance for Needy Families (TANF) and State Children's Health Insurance Programs (SCHIP) to Supplemental Security Income (SSI), Long Term Care and Medicare coverage, they help people of all ages get the care they need and the respect they deserve. Through its many AMERIGROUP Community Care subsidiaries, they currently help more than 1.7 million low-income Americans throughout the nation. The company operates in Florida, Georgia, Maryland, New Jersey, New York, Ohio, South Carolina, Tennessee, Texas, Virginia and the District of Columbia.

In 1994, AMERIGROUP was founded to respond to the growing need for private-sector partners in state managed health care programs for lower-income families and people with disabilities. Since its inception, AMERIGROUP has been a proven leader in meeting the states' objectives of providing accountability and improving access to health care while still controlling care costs. Today, AMERIGROUP is the largest corporation focused exclusively on the health care needs of Medicaid recipients and the uninsured.

Our mission is to operate a community-focused managed care company with an emphasis on the public sector health care market. We will coordinate our members' physical and behavioral health care, offering a continuum of education, access, care, and outcome, resulting in lower costs, improved quality and better health status for Americans.

If you share our commitment to improving people's lives, AMERIGROUP may have a place for you. We're growing dramatically and would like you to consider working for a leader in the healthcare industry. AMERIGROUP is committed to associate career development and growth, providing unlimited opportunities in a culturally diverse, energetic environment.