DSNP Care Manager

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

📋 Description

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

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

• Create, coordinate, and aid in the execution of personalized, member-centered care plans.

• Identify healthcare needs, obstacles to care, and opportunities for enhancing outcomes.

• Coordinate care and services with members, families, healthcare providers, hospitals, community organizations, and other healthcare professionals.

• Ensure seamless coordination of care throughout the continuum of services.

• Advocate for members and their families to guarantee access to suitable services, programs, and community resources.

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

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

• Monitor healthcare services and member outcomes, irrespective of the care setting.

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

• Recognize changes in member conditions and coordinate timely interventions.

• Maintain accurate, comprehensive, and timely documentation.

• Ensure compliance with care management guidelines, regulatory requirements, and quality standards.

• Support the provision of high-quality, cost-effective care driven by evidence-based clinical practice standards.

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

⛳️ Requirements

• A High School Diploma or GED is required.

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

• A minimum of three (3) years of experience in home care, discharge planning, case management, or a related healthcare environment.

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

• 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).

• Strong understanding of case management standards and best practices.

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

• Familiarity with HEDIS measures and quality improvement principles.

• Proficient understanding of medical terminology.

• Insight into care coordination, resource management, and member advocacy.

• Awareness of community resources and support services available for vulnerable populations.

• 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.