DSNP Care Manager - Hudson & Passaic Counties
$63,000–$84,420 year
RemoteNewark, New Jersey, United States
Job Summary
Assess patients' clinical needs against established guidelines to ensure medically appropriate services and evaluate the necessity and efficiency of care. Develop, coordinate, and assist in the implementation of individualized plans of care for Dual Special Needs members. Monitor medical care activities and outcomes across all sites of service to ensure appropriateness and effectiveness. Advocate for members and families among various sites to coordinate resource utilization and service delivery from diagnosis to outcome. Document accurately and comprehensively based on standards of practice and organization policies. Provide field-based and telephonic case management activities specific to the Dual Special Needs program. This field-based position requires daily local travel and a valid New Jersey driver's license.
Required Qualifications
- High School Diploma/GED
- Bachelor degree preferred or relevant experience in lieu of degree
- Minimum of three (3) years broad clinical experience
- Minimum of three (3) years experience in home care, discharge planning, or case management
- Active Unrestricted NJ SW/RN/LPN License or CSW
- Strong knowledge of the standards of practice for case managers
- Strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS)
- Knowledge of medical terminology
- Strong organizational skills
- Strong oral and written communication skills
- Good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)
- Good problem solving and conflict resolution skills
- Ability to work with limited daily supervision
- Valid New Jersey State License and Insurance
- Daily local travel
- Live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Desired Qualifications
- Bachelor degree preferred or relevant experience in lieu of degree
- Experience with the elderly frail population
- Preference with knowledge of managed care principles
- Passion about making an impact
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