RN Case Manager - Hybrid

Duties 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. Through the use of clinical tools and data review, the Case Manager conducts comprehensive assessments of referred members’ needs and eligibility, determines an approach to case resolution and/or meeting needs, evaluates members’ benefit plans and available internal and external programs/services, applies and interprets applicable criteria and guidelines, standardizes case management plans, applies policies, procedures, and regulatory standards while assessing benefits and members’ needs to ensure appropriate administration of benefits. The Case Manager also utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Qualifications Requires an RN with an unrestricted active license in NJ Must be located in Camden County or surrounding counties Three 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 Shift Monday to Friday, 8 am – 5 pm Benefits Medical, prescription, dental, vision, AD&D, and life insurance offerings Short‑term disability 401(k) plan (eligibility required) Equal Opportunity Employer Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. #J-18808-Ljbffr