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RN Care Manager-Bilingual Bengali

About us:

Centers Plan for Healthy Living (CPHL), is a Managed Care Organization servicing members with Medicare and/or Medicaid.  Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CPHL is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community.

 

Summary

Assesses, formulates plans and provides assistance to members and their families in conjunction with the interdisciplinary team. Provides social services support to the member and/or caregiver as identified.  Provides support to members who are transitioning from an acute care facilities back to the community.  Provides support to CPHL Care Managers and other departments in day-to-day care management activities as needed.

 

DUTIES AND RESPONSIBITIES:

  • ·  Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
  • ·  Develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary
  • caregiver, the primary and attending physicians, and various other providers involved in the member’s care.
  • ·  Initiates utilization review for preauthorization and post service reviews
  • ·  Utilizes knowledge of community resources and the member’s benefit structure
  • ·  Interacts with providers and facilities in a professional, respectful manner 
  • ·  Recognizes quality of care issues and escalates the issues appropriately
  • ·  Assists members with the coordination of services from various settings as appropriate
  • ·  Complies with all CPHL’s standards for documentation
  • ·  Participates in case rounds
  • ·  Participates in on call coverage
  • ·  Participates in other meetings as requested
  • ·  Participates in quality improvement initiatives
  • ·  Other duties as assigned
     
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