DSNP Care Manager

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🔥 3 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $63k - $84.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

🚘 Automotive

🏥 Healthcare

⚖️ Legal

Automotive • Healthcare • Legal

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 Description

• Assesses patient's clinical needs against established guidelines and/or standards to ensure that the services provided are medically appropriate to members needs. • Evaluates the necessity, appropriateness and efficiency of services provided. • Develops, coordinates and assists in implementation of members'- individualized plan of care. • Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. • Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. • Documents accurately and comprehensively based on the standards of practice and current organization policies. • Provides field based and/or telephonic case management activities specific to the Dual Special Needs program.

🎯 Requirements

• Requires a High School diploma or GED • Bachelor's degree from an accredited college or university preferred • Requires a minimum of three (3) years broad clinical experience • Requires a minimum of three (3) years experience in home care, discharge planning, or case management • Preferably with the elderly frail population • Requires a minimum of three (3) year experience in the health care delivery system/industry • Active Unrestricted NJ SW/RN/LPN License Required • Requires strong knowledge of the standards of practice for case managers • Requires strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS) • Required knowledge of medical terminology • Prefers knowledge of managed care principles • 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 ability to work with limited daily supervision

🏖️ Benefits

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