Care Manager

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Evaluate the clinical, functional, and psychosocial needs of members through established clinical guidelines and care management standards.

• Assess the medical necessity, appropriateness, and effectiveness of the services being provided.

• Create, coordinate, and assist in the execution of personalized, member-centered care plans.

• Identify healthcare needs, barriers to access, and opportunities to enhance outcomes.

• Collaborate with members, families, physicians, hospitals, community organizations, and other healthcare providers to coordinate care and services.

• Ensure comprehensive care coordination throughout the entire continuum, from diagnosis to treatment and ongoing support.

• Advocate for members and their families to guarantee access to essential services, programs, and community resources.

• Facilitate the utilization of resources and service coordination across various care environments.

• Deliver field-based and telephonic case management services for SNP members.

• Monitor healthcare services and member outcomes, irrespective of the care location.

• Track member progress and assess the effectiveness of interventions and care plans.

• Identify changes in member conditions and coordinate timely interventions as necessary.

• Maintain precise, comprehensive, and timely documentation in line with professional standards and organizational policies.

• Ensure compliance with care management guidelines, regulatory requirements, and quality standards.

• Support the provision of high-quality, cost-effective care informed by evidence-based clinical practice standards.

• Foster quality outcomes through continuous assessment, monitoring, and follow-up.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• At least three (3) years of extensive clinical experience is required.

• A minimum of three (3) years of experience in home care, discharge planning, case management, or a similar healthcare environment.

• At least three (3) years of experience within the healthcare delivery system.

• A current, unrestricted New Jersey license as one of the following: Registered Nurse (RN), Licensed Practical Nurse (LPN), Social Worker (SW), or Certified Social Worker (CSW).

• Strong understanding of case management standards and best practices is essential.

• In-depth knowledge of managed care concepts and healthcare delivery systems is required.

• Familiarity with HEDIS measures and quality improvement principles is necessary.

• Solid understanding of medical terminology is crucial.

• Knowledge of care coordination, resource management, and member advocacy is essential.

• Awareness of community resources and support services accessible to vulnerable populations is important.

• Experience with elderly, frail, disabled, or complex-needs populations is preferred.

• Experience in supporting Medicare, Medicaid, Dual Eligible, or Special Needs Plan (SNP) populations is preferred.

• Background in conducting field-based care management and home visits is preferred.

• Familiarity with dual eligibility programs and government-sponsored healthcare plans is preferred.

• Knowledge of population health management and chronic condition management is preferred.

• Understanding of social determinants of health and their impact on healthcare outcomes is preferred.

• Experience in coordinating care across medical, behavioral health, and community-based services is preferred.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement