Care Manager

Vaga não está no LinkedIn

🕒 2 dias atrás

🦌 Connecticut, New Jersey, +2 estados a mais – Remoto

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $63.000 - $84.420 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 14%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 2 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.

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Horizon Connect @ Wall BCBSNJ

SiteLinkedInTodas as Vagas

2 - 10 funcionários

⚕️ Seguro de Saúde

🏥 Saúde

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ é uma presença no LinkedIn ou programa/escritório local associado ao Horizon Blue Cross Blue Shield de New Jersey (BCBSNJ). Com base no nome e no contexto, parece estar conectado às operações de seguro de saúde do Horizon BCBSNJ e ao alcance local ou envolvimento de membros/provedores na área de Wall, NJ. As informações disponíveis publicamente são limitadas e consistem principalmente na interface do site do LinkedIn em vez de um perfil da empresa, então essa descrição é conservadora e baseada na afiliação indicada pelo nome.

Descrição

• Assess members' clinical, functional, and psychosocial needs using established clinical guidelines and care management standards. • Evaluate the medical necessity, appropriateness, and effectiveness of services provided. • Develop, coordinate, and support implementation of individualized, member-centered care plans. • Identify healthcare needs, barriers to care, and opportunities to improve outcomes. • Coordinate care and services with members, families, physicians, hospitals, community organizations, and other healthcare providers. • Ensure seamless care coordination across the continuum of care, from diagnosis through treatment and ongoing support. • Advocate for members and families to ensure access to appropriate services, programs, and community resources. • Facilitate resource utilization and service coordination across multiple care settings. • Provide field-based and telephonic case management services for -SNP members. • Monitor healthcare services and member outcomes regardless of the site of care. • Track member progress and evaluate the effectiveness of interventions and care plans. • Identify changes in member conditions and coordinate timely interventions as needed. • Maintain accurate, thorough, and timely documentation in accordance with professional standards and organizational policies. • Ensure adherence to care management guidelines, regulatory requirements, and quality standards. • Support delivery of high-quality, cost-effective care guided by evidence-based clinical practice standards. • Promote quality outcomes through ongoing assessment, monitoring, and follow-up.

🎯 Requisitos

• High School Diploma or GED required. • Minimum of three (3) years of broad clinical experience. • Minimum of three (3) years of experience in home care, discharge planning, case management, or a related healthcare setting. • Minimum of three (3) years of experience working within the healthcare delivery system. • 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 knowledge of case management standards and best practices. • Strong understanding of managed care concepts and healthcare delivery systems. • Knowledge of HEDIS measures and quality improvement principles. • Strong knowledge of medical terminology. • Understanding of care coordination, resource management, and member advocacy. • Knowledge of community resources and support services available to vulnerable populations. • Experience working with elderly, frail, disabled, or complex-needs populations preferred. • Experience supporting Medicare, Medicaid, Dual Eligible, or Special Needs Plan (SNP) populations preferred. • Experience conducting field-based care management and home visits preferred. • Familiarity with dual eligibility programs and government-sponsored healthcare plans preferred. • Knowledge of population health management and chronic condition management preferred. • Understanding of social determinants of health and their impact on healthcare outcomes preferred. • Experience coordinating care across medical, behavioral health, and community-based services preferred.

🏖️ Benefícios

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement

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