Hybrid Care Manager

at NJM Insurance Group

• Job title: Care Manager
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $62,100 - $83,160 per year
• Degree requirement: High School Diploma
• Location requirements: Hybrid, Hopewell, United States

About the role

• Case Manager responsible for assessing clinical needs and developing care plans for Dual Special Needs members. Collaborating with health care professionals and families to ensure appropriate care delivery.

Responsibilities

• Assesses patient's clinical needs against established guidelines and/or standards to ensure that the services provided are medically appropriate to members needs.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of members- individualized plan of care.
• Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.
• Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
• Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Provides field based and/or telephonic case management activities specific to the Dual Special Needs program.

Requirements

• High School Diploma/GED required
• Bachelor degree preferred or relevant experience in lieu of degree
• Requires a minimum of three (3) years broad clinical experience
• Requires a minimum of three (3) years experience in home care, discharge planning, or case management. Preferably with the elderly frail population.
• Requires a minimum of three (3) year experience in the health care delivery system/industry.
• Active Unrestricted NJ SW/RN/LPN License or CSW Required
• Requires strong knowledge of the standards of practice for case managers.
• Requires strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS).
• Required knowledge of medical terminology.
• Prefers knowledge of managed care principles.
• Prefer experience with elderly frail population.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement