Care Manager I, Specialty Programs

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🕒 5 dias atrás

🏖️ New Jersey – Remoto

🏖️ New Jersey – Remote

💵 $70.500 - $94.395 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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NJM Insurance Group

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1913

Insurance

O NJM Insurance Group é um provedor de seguros consolidado que oferece uma gama de produtos de seguros pessoais e comerciais. Seus serviços incluem seguros de auto, residencial, locatários, condomínio, auto comercial e seguros empresariais, com foco em excepcional satisfação do cliente e experiência em reivindicações. A NJM é reconhecida por sua excelente experiência em sinistros de automóveis pela J. D. Power e está comprometida em atender clientes em estados como Connecticut, Maryland, Nova Jersey, Ohio e Pensilvânia. A empresa se orgulha de ser direta e centrada no cliente, sem jingles ou mascotes, oferecendo soluções de seguro confiáveis e múltiplas oportunidades de desconto para várias apólices.

Descrição

• Assess member’s clinical need against establish guidelines and/or standards for specialty population-based members. • Implement 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. • Partner with the member/family, physician, and all members of the healthcare team to ensure the member’s needs are met, internal and external to this organization. • Advocate for the member among various sites to coordinate resource utilization. • Utilize 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. • Ensure care for mandated non-compliant members through the monitoring of utilization. • Document accurately and comprehensively based on the standards of practice and current organization policies. • Evaluate care by problem solving, analyzing variances, and participating in quality improvement to enhance member outcomes. • Monitor member’s care activities, regardless of the site of service or network participation, and outcomes for appropriateness and effectiveness. • Consult with internal stakeholders on complex cases and escalate as appropriate to internal physician resources. • Complete other assigned functions as requested by management.

🎯 Requisitos

• Requires a license as an RN, or Bachelor's degree in social work, health or behavioral science. • Graduate level degree in Social Work or Health and Behavioral Science preferred. • Requires a minimum of three (3) years’ experience serving members with special needs. • Requires strong knowledge of the standards of practice for case managers. • Requires strong knowledge of managed care principles. • Requires strong knowledge of specialty population, as applicable. • 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 a car with valid New Jersey State License and Insurance for certain positions.

🏖️ Benefícios

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