Care Manager I, Specialty Programs

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

📋 Description

• Evaluate the clinical needs of members in accordance with established guidelines and standards for specialty population-based members.

• Deliver high-quality, cost-effective care through a tailored population model supported by clinical practice guidelines defined by the organization.

• Collaborate with members/families, physicians, and the entire healthcare team to address the needs of the member, both within and outside of the organization.

• Act as an advocate for the member, coordinating resource utilization across various sites.

• Employ the care management process to prioritize, plan, organize, and implement goal-oriented interventions aimed at achieving self-care outcomes and facilitating a transition to independent status.

• Ensure compliance in care for mandated non-compliant members by monitoring their utilization.

• Maintain accurate and comprehensive documentation in line with established standards of practice and organizational policies.

• Assess care effectiveness by problem-solving, analyzing variances, and engaging in quality improvement initiatives to enhance member outcomes.

• Oversee member care activities and outcomes for appropriateness and effectiveness, regardless of the service site or network involvement.

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

• Perform additional duties as assigned by management.

⛳️ Requirements

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

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

• At least three (3) years of experience working with members who have special needs is necessary.

• A strong understanding of the standards of practice for case managers is required.

• In-depth knowledge of managed care principles is essential.

• Familiarity with specialty populations, as applicable, is required.

• Strong organizational skills are necessary.

• Excellent oral and written communication skills are required.

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

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

• A valid New Jersey State License and Insurance for a car is required for certain positions.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement