Care Manager I, Specialty Programs

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

📋 Description

• Carry out care coordination responsibilities in accordance with established guidelines to ensure an appropriate level of care and facilitate transitions to the continuum of care for specialized populations.

• Execute interventions that promote efficient utilization of benefits.

• Evaluate members’ clinical requirements based on established guidelines and standards.

• Deliver high-quality, cost-effective care tailored to customized population models and clinical practice guidelines.

• Collaborate with members/families, healthcare providers, and teams to address member needs.

• Advocate for members across various sites and coordinate the use of resources.

• Prioritize, plan, organize, and implement goal-oriented interventions that support self-care outcomes and a transition to independence.

• Ensure care for mandated non-compliant members through ongoing utilization monitoring.

• Document information accurately and thoroughly in accordance with practice standards and organizational policies.

• Assess care, troubleshoot issues, analyze variances, and engage in quality improvement initiatives.

• Oversee care activities and outcomes to ensure appropriateness and effectiveness.

• Consult with internal stakeholders on complex cases and escalate to internal physician resources as necessary.

• Perform additional assigned tasks as directed by management.

⛳️ Requirements

• A valid RN license or a Bachelor’s degree in social work, health, or behavioral science is required.

• A minimum of three (3) years’ experience working with members with special needs is mandatory.

• A graduate-level degree in Social Work or Health and Behavioral Science is preferred.

• Strong knowledge of case management practice standards is essential.

• In-depth understanding of managed care principles is required.

• Comprehensive knowledge of specialty populations, as applicable, is necessary.

• Excellent organizational skills are required.

• Strong oral and written communication skills are a must.

• Proficiency in PC skills and the ability to use Microsoft Office applications (Excel, Access, Word, etc.) is necessary.

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

• A vehicle with a valid New Jersey State License and Insurance is necessary for certain positions.

• Employees must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement