Care Manager I – Specialty Programs, Childhood Lead Program

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

📋 Description

• Evaluate the clinical needs of members in relation to set guidelines and standards for specialized populations.

• Deliver high-quality, cost-effective care utilizing tailored population models and clinical practice protocols.

• Collaborate with members, their families, physicians, and healthcare team members to address member requirements.

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

• Establish priorities, plan, organize, and execute interventions aimed at achieving self-care outcomes and promoting independent status.

• Oversee utilization to ensure appropriate care for mandated non-compliant members.

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

• Assess care through problem-solving, variance analysis, and participation in quality improvement initiatives.

• Supervise care activities and outcomes for appropriateness and efficacy across service sites and networks.

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

• Carry out additional functions as assigned by management.

⛳️ Requirements

• Must possess a license as a Registered Nurse (RN) or hold a bachelor’s degree in social work, health, or behavioral science.

• 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.

• Extensive knowledge of case management standards of practice.

• Strong understanding of managed care principles.

• In-depth knowledge of specialty populations, as relevant.

• Excellent organizational abilities.

• Proficient oral and written communication skills.

• Competent in PC usage and adept with Microsoft Office applications, including Excel, Access, and Word.

• Strong problem-solving and conflict-resolution capabilities.

• A valid New Jersey State License and insurance are required for certain positions, along with a reliable vehicle.

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

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous Paid Time Off (PTO)

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement