Care Manager

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

📋 Description

• Evaluate patients' clinical requirements in accordance with established guidelines and standards to confirm that services are medically suitable.

• Analyze the necessity, suitability, and effectiveness of the services rendered.

• Create, coordinate, and assist in the execution of individualized care plans for members.

• Collaborate with patients, families, physicians, hospitals, and other external parties to assess the appropriateness of care from diagnosis through to outcome.

• Ensure the delivery of high-quality, cost-effective care throughout the continuum using clinical practice guidelines.

• Oversee patients' medical care activities and outcomes across all service locations.

• Act as an advocate for members and families at various sites to manage resource utilization and assess services.

• Accurately and comprehensively document in alignment with standards of practice and organizational policies.

• Engage in field-based and/or telephonic case management activities for the Dual Special Needs program.

⛳️ Requirements

• High School Diploma/GED is required.

• A Bachelor's degree is preferred, or relevant experience may be accepted in lieu of a degree.

• A minimum of three (3) years of extensive clinical experience is required.

• At least three (3) years of experience in home care, discharge planning, or case management is required, preferably with the elderly frail population.

• A minimum of three (3) years of experience within the healthcare delivery system/industry is required.

• An active unrestricted NJ SW/RN/LPN License or CSW is required.

• Strong knowledge of case management standards of practice is necessary.

• In-depth understanding of managed care principles and concepts, including Health Plan Effectiveness Data and Information Sheet (HEDIS), is required.

• Familiarity with medical terminology is essential.

• Strong organizational abilities are required.

• Excellent oral and written communication skills are essential.

• Proficient PC skills and the ability to use Microsoft Office applications (Excel, Access, Word, etc.) are required.

• Strong problem-solving and conflict resolution skills are necessary.

• Good presentation skills are required.

• Ability to work with minimal daily supervision is essential.

• A valid New Jersey State driver's license and insurance are required.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement