Care Manager, DSNP

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

📋 Description

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

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

• Create, coordinate, and assist in the implementation of personalized, member-focused care plans.

• Identify healthcare needs, obstacles to care, and potential opportunities to enhance outcomes.

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

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

• Advocate for members and families to secure access to appropriate services, programs, and community resources.

• Facilitate resource utilization and service coordination across various care settings.

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

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

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

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

• Maintain precise, comprehensive, and prompt 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 guided by evidence-based clinical practice standards.

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

⛳️ Requirements

• A High School Diploma or GED is mandatory.

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

• At least three (3) years of experience in home care, discharge planning, case management, or a similar healthcare setting is necessary.

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

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

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

• Comprehensive knowledge of managed care concepts and healthcare delivery systems is necessary.

• Familiarity with HEDIS measures and principles of quality improvement is essential.

• Proficient knowledge of medical terminology is required.

• Understanding of care coordination, resource management, and member advocacy is important.

• Knowledge of community resources and support services available to vulnerable populations is necessary.

• Horizon BCBSNJ employees must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits including Medical, Dental, and Vision.

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.