Nurse Case Manager II

Nurse Case Manager II

Our client, a Retail Pharmacy company, is looking for a Nurse Case Manager II for their Northern or Central Counties, NJ (Monmouth, Morris, Somerset, Union, Passaic, Bergen, Essex) location.

Responsibilities:

• The care manager is responsible for assessing and evaluating members with potential care management needs through telephonic and face to face assessments in various settings, including the member's private residence, hospitals, behavioral, and long term nursing facilities.
• The care manager establishes a cost effective and member centric care plan in collaboration with the member, authorized care givers, and providers.
• The care manager monitors and evaluates the effectiveness of the care plans and adjust the care plan based on clinical judgement and member needs.
• Care managers coordinate and collaborate with members, authorized representatives, primary care providers, and other care team participants to coordinate services and ensure timely service delivery.
• The care manager will take an interdisciplinary approach to advocate for member's needs to ensure a safe discharge post hospitalization or transition from a nursing facility, including addressing social needs (e.g., housing and food insecurity).
• Accurate and timely documentation in the member's electronic health record is essential.
• The care manager role requires critical thinking, problem-solving skills, and the ability to work autonomously.
• Additionally, the care manager may be asked to mentor new hires once proficient in the role.
• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
• Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
• The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Requirements:

• MCO experience preferred
• BSN or LSW required
• MUST be an experienced/seasoned case worker
• Verifyable High School Diploma or GED Required
• 3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
• Healthcare and/or managed care industry experience.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
• Effective communication skills, both verbal and written.
• Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
• Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
• Typical office working environment with productivity and quality expectations
• Case Management Certification CCM preferred

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities