Support EmblemHealth population health complex care management initiatives by providing care management services engaging with the most complex individuals enrolled in care management programs. Provide oversight to a multidisciplinary care team responsible for a population of health plan enrollees in a discrete "geo panel" or care pod
Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate and timely utilization of services. Serve as the "quarterback" or "leader" of a geo pod ( care team) who will assess and triage members to the most appropriate level of support needed.

Responsibilities:

• Assess and evaluate needs of our most complex members, coordinating care utilizing the most appropriate resources to support member needs. This includes member and family as appropriate.

• Engage actively with the member PCP /designee

• Engage with the member in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes for member

• Act as the "triage" lead for the care team to identify members with changing conditions in the geo panel supporting navigation to the most appropriate individuals

• Assess the needs of members in the geo panel and align them with the appropriate member of the care team (disease manager, behavioral healthcare manager, pharmacist, social worker)

• Monitor care team performance to ensure that members of the geo panel are engaged in a timely fashion and that performance metrics ( Admits/K, ER utilization, etc.) meet or exceed established thresholds

• Provide ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care

• Serve as an informal leader of the team with the goal of maintaining team performance and high morale.

Qualifications:

• Bachelor's degree from an accredited college or university

• Current New York State RN license

• CCM certified required, but consideration will be given for current enrollees (candidates actively seeking certification)

• 5 to 8 years of clinical experience (R)

• Prior health plan experience highly desirable (R)

• Excellent verbal and written communication skills required (R)

• Computer proficiency required (R)

Additional Information

• Requisition ID: 220K4