This is a fully remote position, open to applicants in New Jersey.

• Evaluates the clinical needs of patients in accordance with established guidelines and standards.

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

• Develops, coordinates, and aids in the execution of individualized care plans for members.

• Collaborates with patients, families, physicians, hospitals, and other external stakeholders.

• Ensures the provision of high-quality, cost-effective care.

• Oversees the medical care activities and outcomes of patients to ensure appropriateness and effectiveness.

• Advocates for members and their families across various locations.

• Maintains accurate and comprehensive documentation in line with practice standards.

• Conducts field-based and/or telephonic case management activities specific to the Dual Special Needs program.

• Must possess a High School diploma or GED.

• A Bachelor’s degree from an accredited institution is preferred.

• Requires at least three (3) years of extensive clinical experience.

• Must have a minimum of three (3) years of experience in home care, discharge planning, or case management.

• Experience with the elderly frail population is preferred.

• Requires a minimum of three (3) years of experience within the healthcare delivery system or industry.

• An active Unrestricted NJ SW/RN/LPN License is required.

• Must possess a strong understanding of the standards of practice for case managers.

• Requires solid knowledge of managed care principles and concepts, including Health Plan Effectiveness Data and Information Set (HEDIS).

• Knowledge of medical terminology is essential.

• Familiarity with managed care principles is preferred.

• Experience with the elderly frail population is preferred.

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

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.

Care Manager

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