Care Manager - ED (RN)

Job Description

A client of Innova Solutions is immediately hiring for a Care Manager - New York, NY (Hybrid)

Position type : Contract - Fulltime

Duration : 3+ Months

Location : New York, NY

Description :

As a Care Manager you will be doing : -

• Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business.
• Develop a working relationship with the PCP to be able to contact and discuss the care of the members with them.
• Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team.
• Identify the risk factors and assign the risk category to the member.
• As part of Care Management team, we develop a formal care plan for all services needed for the members, including the members’ disaster plan.
• Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary.
• Identify clinical issues that require immediate clinical assessment and / or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
• Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care.
• Prior approve request for additional services based on assessments and using evidence-based standards refer denial, reduction, or limitation of service request to Medical Director.
• Assist members with the coordination of services both within and outside networks as appropriate. Includes facilitating discharge from acute settings and alternate settings.
• Provides Care Coordination through continuum of care.
• Optimizes both the quality of care and the quality of life for the members.
• Coordinate with Utilization Management (UM) department on concurrent and retrospective review.
• Follow up with assigned nurses for clinical updates to care plan.
• Document within two business days’ coordination notes and routine contacts with the members according to the level of risk assigned to them.
• Participate in team care planning meetings.
• Handling complaints that can be resolved in one day
• Assists Customer Service and the UM department by providing records and materials needed for grievances from MLTC / MAP program members
• Speaks to members who are delinquent in their spend-down payments.
• Cooperate with all departments.
• Identifies members appropriate for specialty programs.
• Performs all MLTC / MAP management activities in compliance with all regulatory agency requirements.
• Provides information on all requests from Quality Management Department to be reviewed by the various Quality committees.
• Completes all other tasks assigned by MLTC Department Leadership.
• Participate in the department on call schedule / being on call, which is rotated amongst the care team.

Qualifications (Must Haves) :

License Requirement :

The ideal candidate will have : Five years minimum of clinical experience as a Registered Nurse. Experience with Care Coordination, Utilization review and discharge planning Computer literacy required.

Qualified candidates should  APPLY NOW  for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.

We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines.  ASK ME HOW.

Thank you!

Jatin Khurana

470-851-2794

Jatin.Khurana@innovasolutions.com

PAY RANGE AND BENEFITS :

Pay Range

Benefits :  Innova Solutions offers benefits( based on eligibility) that include the following : Medical & pharmacy coverage, Dental / vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS : Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions :

Website :

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates.  If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed.  Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities.   Innova Solutions (HireGenics / Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.

The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.

Innova Solutions offers a referral bonus for qualified Ambassadors who refer eligible referrals. Submit referrals at and earn $250-$1,000 per referral.