Care Manager, DSNP

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut, New Jersey, +2 more states – Remote

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

💵 $63k - $84.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 16%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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

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