SNP Care Manager

Stelle nicht auf LinkedIn

đź•’ vor 20 Tagen

🦌 Connecticut, New Jersey, +2 weitere Bundesländer – Remote

infoinfo

đź’µ $63.000 - $84.420 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

đźź  Senior

đź‘” Manager

🗣️🇺🇸🇬🇧 Englisch erforderlich

Woher diese Stelle stammt

Veröffentlicht auf der Karriereseite von Horizon Connect @ Wall BCBSNJ, nicht über eine Jobbörse

Von Remote Rocketship zum ersten Mal gesehen vor 20 Tagen

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Logo of Horizon Connect @ Wall BCBSNJ

Horizon Connect @ Wall BCBSNJ

2 - 10 Mitarbeiter

⚕️ Krankenversicherung

🏥 Gesundheitswesen

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ ist eine LinkedIn-Präsenz oder ein lokales Programm/Büro, das mit Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) verbunden ist. Basierend auf dem Namen und Kontext scheint es mit den Krankenversicherungsoperationen von Horizon BCBSNJ und der lokalen Öffentlichkeitsarbeit oder Mitglieder-/Anbieterbindung im Wall, NJ Gebiet verbunden zu sein. Öffentlich zugängliche Informationen sind begrenzt und bestehen hauptsächlich aus allgemeinen LinkedIn-Seiteninformationen statt einem Unternehmensprofil, daher ist diese Beschreibung konservativ und basiert auf der durch den Namen angezeigten Verbindung.

Beschreibung

• 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

🎯 Anforderungen

• 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 • Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

🏖️ Vorteile

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

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🦅 H1B-Visum-Sponsor

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🗣️🇺🇸🇬🇧 Englisch erforderlich

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