Remote Pediatric Case Manager RN : Medically Fragile/Foster Care Pop/Medicaid – New York

Summary of Position

• Provide confidential administrative support/assistance to the department; support the department in all aspects of daily ops.
• Ensure high-touch coordination with Office of Children and Family Services (OCFS), Local Departments of Social Services (LDSS,) and (if applicable) the Voluntary Foster Care Agency (VFCA), the member is enrolled in, for all members in foster care, including oversight and coordination of the Foster Care requirements.
• Act as Subject Matter Expert with the necessary experience, expertise and knowledge of the member’s welfare system, foster care healthcare requirements and the unique complex needs (including resultant of trauma) of the Foster Care population.
• Serve as the direct Plan contact for coordinators and service providers, responsible for monitoring access for members in

foster care.

Principal Accountabilities

• Communicate relevant notification from LDSS coordinator when a member in foster care is enrolled in the managed care plan or when a current managed care member is entering foster care.
• Support the counties in addressing issues for managed care members in foster care.
• From foster care or disenrollment from an MCO.
• Collaborate with LDSS coordinator to ensure assessments are completed on time.
• Assist with care coordination if member is considered unstable by HCP or LDSS; or has a chronic condition.
• Report to the LDSS foster care coordinator any change in member’s status (i.e., address, health status, etc.).
• Assist with discharge
• Collaborate with LDSS coordinator to ensure continuity of care plans are in place upon disenrollment or discharge from foster care.
• Collaborate with LDSS coordinator to ensure that the LDSS and MCO (if plan transfer) are aware of the transition and current care plan can be coordinated.
• Participate in the development of project plans; tracking and management of projects; and departmental activities related to foster care schedule and cost.
• Perform other duties as directed, requested, assigned, or required.

Qualifications – External

Education, Training, Licenses, Certifications

• Bachelor’s degree, preferably in Nursing.
• Current unrestricted New York State RN license.
• CCM certification required, or successful completion of certification within 180 days of hire date as a condition of continued

employment.

Relevant Work Experience, Knowledge, Skills, and Abilities

• 4 – 6+ years of relevant work experience, preferably with a healthcare provider (R)
• 3 – 4+ years of clinical experience, including Medicaid experience. (R)
• Additional experience/specialized training may be considered in lieu of educational requirements. (R)
• Health plan experience, preferably in a clinical setting. (P)
• Experience with Population Health Management. (R)
• Experience with managing people/processes in care management settings. (R)
• Strong organizing, prioritizing, and problem identification and solving skills. (R)
• Analytical skills; attention to detail. (R)
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences. (R)
• Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.). (R)
• Proven track record of successfully completing projects/tasks in alignment with overall strategies. (R)

Additional Information

• Requisition ID: 1000001269
• Please apply directly on our career site: https://careers.emblemhealth.com/jobs/medicare-nurse-pediatric-case-manager-medically-fragile-foster-care-population-5832
• Hiring Range: $63,000-$110,000

Job Type: Full-time

Pay: $63,000.00 – $110,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Medical specialties:

• Pediatrics

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Remote

Experience:

• Medicaid: 3 years (Preferred)
• Case management: 3 years (Preferred)
• Pediatrics: 1 year (Preferred)

License/Certification:

• NY RN license (Required)

Work Location: Remote