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Responsibilities
Work Schedule:
- Monday to Friday, 8:00 AM to 5:00 PM EST.
Candidate Requirements:
- Candidates must include their city, state, zip code, and county of residence at the top of their resume.
- Northern or Central New Jersey counties considered: Monmouth, Morris, Somerset, Union, Passaic, Bergen, Essex.
- MCO experience preferred.
- BSN or LSW required.
- Must be listed on resume: RN with current unrestricted state licensure in the State of New Jersey.
- Must be an experienced/seasoned caseworker.
Care Manager Responsibilities:
- Assessing and evaluating members with potential care management needs through telephonic and face-to-face assessments in various settings, including the member’s private residence, hospitals, behavioral, and long-term nursing facilities.
- Establishing a cost-effective and member-centric care plan in collaboration with the member, authorized caregivers, and providers.
- Monitoring and evaluating the effectiveness of care plans and adjusting them based on clinical judgment and member needs.
- Coordinating and collaborating with members, authorized representatives, primary care providers, and other care team participants to coordinate services and ensure timely service delivery.
- Taking an interdisciplinary approach to advocate for member’s needs to ensure a safe discharge post-hospitalization or transition from a nursing facility, including addressing social needs (e.g., housing and food insecurity).
- Accurate and timely documentation in the member’s electronic health record.
- Critical thinking, problem-solving skills, and the ability to work autonomously.
- Mentoring new hires once proficient in the role.
Duties:
- Through the use of clinical tools and information/data review, conducting comprehensive assessments of referred member's needs/eligibility and determining the approach to case resolution and/or meeting needs by evaluating the member's benefit plan and available internal and external programs/services.
- Applying and/or interpreting applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
- Utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Experience:
- 3 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
- Healthcare and/or managed care industry experience.
- Case Management experience preferred.
- Proficiency with computer skills, which includes navigating multiple systems and keyboarding.
- Effective communication skills, both verbal and written.
- Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.
Physical Requirements:
- Sedentary work involving periods of sitting, talking, and listening.
- Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
- Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
Work Environment:
- Typical office working environment with productivity and quality expectations.
Position Summary:
- The Case Manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Education:
- BSN, RN with current unrestricted state licensure or MSW/LOSW.
- Requires an RN with unrestricted active license in NJ (single or compact licensure).
- Case Management Certification CCM preferred.
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