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DDD Case Manager
1 month ago
Remote role - Expectation to join in office meeting once a month or more if needed. Candidate must be within driving distance
Job Summary:
- Provides telephonic case management for Medicaid eligible individuals with intellectual and/or developmental disabilities who are actively linked with the State of New Jersey’s Division of Developmental Disabilities and/or The Department of Children and Families Children’s System of Care.
- This position is accountable for the management of high-risk level cases identified through the care management program to ensure effective implementation of interventions, and to ensure efficient utilisation of benefits.
Qualifications:
- Education/Experience: Prefers a bachelor’s degree. Requires a minimum of two years business experience, preferably in a medical support related position or health insurance environment.
- For RN’s/LPN’s, requires an active unrestricted NJ RN/LPN License or active Compact License Required.
- For Social Workers, requires an unrestricted New Jersey Certified Social Worker (CSW.) Prefers current New Jersey License Social Worker (LSW) or License Clinical Social Worker (LCSW)
Responsibilities:
- Conducts high-level assessment and planning for selected population-based members.
- Collaborates with the member/family, physician and all members of the healthcare team, internal and external to this organisation.
- Coordinates the delivery of high quality, cost-effective care based on a customised population model of care supported by clinical practice guidelines established by the plan.
- Advocates for the member/family among various sites to coordinate resource utilisation and evaluation of services provided.
- Interacts with the member/family, physician and healthcare team.
- Utilizes the care management process to set priorities, plan, organise, and implement interventions that are goal directed toward self-care outcomes, and the transition to independent status.
- Encourages member participation and compliance in the care management program efforts.
- Utilises population-based case management process for goal directed member/family care.
- Documents accurately and comprehensively based on the standards of practice and current organisation policies.
- Interacts and communicates telephonically, striving for continuity and efficiency as the member is managed along the continuum of care.
- Understands fiscal accountability and its impact on the utilisation of resources, proceeding to self-care outcomes.
- Evaluates care by problem solving, analysing variances and participating in the quality improvement program to enhance member outcomes.
- Provides telephonic case management activities specific to the care management program.
Knowledge:
- Requires strong knowledge of the standards of practice for case managers.
- Requires strong knowledge of managed care principles and concepts including Health Plan Employer Data and Information Sheet (HEDIS).
Skills and Abilities:
- Requires strong organisational skills.
- Requires strong oral and written communication skills.
- Requires good PC skills and the ability to utilise Microsoft Office applications (Excel, Access, Word, etc.)
- Requires good problem solving and conflict resolution skills.
- Requires good presentation skills.
- Requires Project Management Skills
