Nursing - Case Manager

2 weeks ago

Hopewell, United States Integrated Resources Full time
Job Description: Job Title: DDD Case Manager
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 utilization of benefits.
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 organization.
• Coordinates the delivery of high quality, cost-effective care based on a customized population model of care supported by clinical practice guidelines established by the plan.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Interacts with the member/family, physician and healthcare team.
• Utilizes the care management process to set priorities, plan, organize, 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.
• Utilizes population-based case management process for goal directed member/family care.
• Documents accurately and comprehensively based on the standards of practice and current organization 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 utilization of resources, proceeding to self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Provides telephonic case management activities specific to the care management program.

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.)
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 organizational skills.
• Requires strong oral and written communication skills.
• Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)
• Requires good problem solving and conflict resolution skills.
• Requires good presentation skills.
• Requires Project Management Skills
* Remote role- Expectation to join in office meeting once a month or more if needed. Candidate must be within driving distance
- 2 submittal slots have been provided per Supplier

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