Job description:   

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. The position requires advanced clinical judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health, psychosocial wrap around services. The care manager will be responsible for; care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing and communication skills are required.   

Fundamental Components/Job Description:  

The Case Manager is responsible for conducting face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports program (MLTSS) and/or Dual Special Needs Program (D-SNP/ FIDE). Care manager may also be responsible for face to face assessments with non-MLTSS members to evaluate the medical needs of the member to facilitate the member’s overall wellness and help them obtain the services they need to thrive by addressing requests for services such as adult medical daycare, pediatric medical daycare, personal care assistant, nursing facility custodial requests, personal preference program and MLTSS program enrollment. Successful completion of company sponsored NJ Choice Certification is requirement for continued employment. Member assignment may include pediatric population and medically complex cases. The case manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants. The case manager schedules and attends interdisciplinary meetings and advocates on the members behalf to ensure proper and safe discharge with appropriate services in place. The case manager works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the MLTSS/ FIDE benefit. The care manager is responsible for documenting accurately and timely in the member’s electronic health record. This position requires the case manager to use critical thinking skills and the ability to problem solve. The Case Manager will also be expected to mentor new hires, once, a level of proficiency has been attained in their role. 50 to 75% travel in Union/ Essex/ Passaic County and surrounding counties. 

• Active and Unrestricted RN license in NJ

• Willing and able to travel 50 to 75% of their time in Union, Essex, and Passaic County and surrounding counties

• 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care

• 1+ years' experience using computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

• Successful completion of the NJ Choice certification is a contingency of employment. As per NJ Division of Aging Services, Office of Community Choice Options guidance, an exam score of 80% or higher is required, along with successful completion of the State training modules, and field mentoring component.  

• Case management and/or discharge planning experience

• Managed Care experience

• Crisis intervention skills

• Experience using electronic medical record systems such as Epic, Cerner, or Meditech