RN Case Manager

RN Case Manager

Our client, a Retail Pharmacy company, is looking for a RN Case Manager for their Camden, Gloucester, Atlantic or Cumberland Counties, NJ location.

Responsibilities:

Help us elevate our patient care to a whole new level! Join our client team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have a life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in markets across the country. Our Integrated Care Management (ICM) Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.

The ICM care manager develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness.

Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.

Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.

Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.

Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.

Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences

Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

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

Requirements:

Minimum 3+ years of clinical practice experience

Must have active and unrestricted RN licensure in the state of NJ

The protection and security of our colleagues is paramount. client encourages it's nurses to meet with members in a public place if they feel that is more appropriate. If needed, security escort is also available.

Certified Case Manager is preferred.

Minimum 2+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience preferred

NJ Choice Certification preferred

Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually

Excellent analytical and problem-solving skills

Effective communications, organizational, and interpersonal skills.

Ability to work independently

Effective computer skills including navigating multiple systems and keyboarding

Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

Bilingual Preferred

Associate degree in nursing

Verifyable High School Diploma or GED Required

Requires an RN with unrestricted active license in the state of NJ

RN with current unrestricted state licensure.

Case Management Certification CCM preferred

Why Should You Apply?

Health Benefits

Referral Program

Excellent growth and advancement opportunities