Insurance Case Manager Jobs in Rochester, NY (NOW HIRING)

Role and Responsibilities

The RN Case Manager will administer skilled nursing care to patients requiring professional nursing service. Teach and supervise the family and other members of the nursing team. Perform these services in accordance with the physician’s orders.

Essential Functions

• Provide and coordinate quality patient care, maintain a full caseload, maintain productivity goals with consideration of case mix, and accurate, timely documentation.
• Responsible to manage each patient’s care as efficiently and cost-effectively as possible, to achieve positive patient outcomes regardless of payer.
• Responsible for the overall plan of care and the outcome of that care, including care delivered by other nursing staff (LPN, HHA) who must be directed and supervised by the RN Case Manager.
• Conduct admission and manage care of patient to the agency by:

• Obtaining a medical history, particularly as it relates to the present condition, from the patient and/or family member(s).
• Conducting a physical examination of the patient including vital signs, physical assessment, mental status, appetite and type of diet, assessment of ADL, and activity of daily living.
• Evaluating the patient, family member(s), and home situation to determine what health teaching will be required.
• Evaluating the patient’s environment to determine what assistance will be available from family members in caring for the patient.
• Evaluating the patient’s condition and home situation to determine if the services of a home health aide will be required and the frequency of this service.
• Interpreting nursing and other services of the agency to patients and families as a part of planning for care.
• Meeting regulatory requirements and having a comprehensive understanding of various insurances.
• Practicing accepted nursing standards with regards to infection control.
• Develop and implement the nursing care plan.

• Provide skilled nursing care as outlined in the nursing care plan to include the following:

• Skilled nursing services, treatments and preventive procedures ordered by the physician.
• Initiating preventive and rehabilitative nursing procedures as appropriate for the patient’s care and safety.
• Observing signs and symptoms and reporting to the physician reactions to treatments, including drugs and changes in the patient’s physical or emotional condition.
• Teaching, supervising, and counseling the patient and caregivers regarding the nursing care needs and other related problems of the patient at home.

• Oversee the care given by Home Health Aides to assigned patients by:

• Supervising and evaluating the care given by the Home Health Aide.
• Applying documentation according to standards of nursing practice.
• Utilizing computer skills for accurate documentation.
• Document those services rendered to the patient, note changes in the patient’s condition and/or family and home situation, make revisions in the nursing care plan as needed, record supervisory visits conducted with the Home Health Aide, evaluate patient care and progress and close charts of discharged patients.

• Other duties as assigned.

This job description reflects management’s assignment of essential functions; and nothing in this herein restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Education Requirements

• Associate’s degree in Nursing required.
• Bachelor’s degree in Nursing preferred.

Qualifications and Requirements

• Current, valid RN license issued by NYS Department of Education required.
• Minimum one year home care experience
• Knowledge of State and Federal regulations, payer guidelines
• Must possess the following skills:

• Excellent communication and critical thinking skills.
• Flexible and organized .
• Ability and desire to serve as a role model.

Work Environment

The RN Case Manager is primarily in a non-office setting and may be exposed to outdoor conditions.

The working conditions are classified as medium work:

• Medium work - Exerting up to 50 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Medium work involves sitting and standing.

Physical Requirements

The following is a description of the physical requirements on a daily basis for the RN Case Manager. While performing the duties of the job the employee is regularly expected to:

• Stand
• Sit
• Hear
• Walk
• Talk
• Stoop or kneel
• Repetitive motion

This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed as assigned.

EOE/AA Minority / Female / Disability / Veteran