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 ensure that services provided are medically appropriate.

• Assess the necessity, appropriateness, and efficiency of the services rendered.

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

• Collaborate with patients, families, physicians, hospitals, and external stakeholders from diagnosis through to outcome.

• Ensure high-quality, cost-effective care throughout the continuum by utilizing clinical practice guidelines.

• Oversee medical care activities and outcomes across various service sites.

• Advocate for members and their families by coordinating resource utilization and appraising services.

• Maintain accurate and thorough documentation in line with practice standards and organizational policies.

• Provide both field-based and telephonic case management for the Dual Special Needs program.

⛳️ Requirements

• High School Diploma/GED is a must.

• A Bachelor’s degree is preferred, or equivalent experience may be considered in lieu of a degree.

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

• A minimum of three (3) years of experience in home care, discharge planning, or case management is necessary.

• At least three (3) years of experience in the healthcare delivery system or industry is essential.

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

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

• Solid knowledge of managed care principles and concepts, including HEDIS, is required.

• Familiarity with medical terminology is essential.

• Excellent organizational skills are required.

• Strong oral and written communication skills are necessary.

• Proficient PC skills and ability to utilize Microsoft Office applications, including Excel, Access, and Word, are required.

• Effective problem-solving and conflict-resolution skills are needed.

• Strong presentation skills are essential.

• Ability to work with limited supervision on a daily basis is required.

• Daily local travel is required.

• A car with a valid New Jersey State license and insurance is mandatory.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous PTO.

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.