Care Manager RN

Newark, NJ 07102

Posted: 03/23/19 Employment Type: 3 months Contract To Hire Industry: Healthcare Job Number: WCG1JP00005691 or WCG1JP00005460

Description:

 

JOB SUMMARY 
Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for a member. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member. 

ESSENTIAL FUNCTIONS 
Note: The following is not intended to be an exhaustive list of all duties required of this position 
Key Duties and Responsibilities 
• Evaluates members for case management services and determines appropriate level of care coordination/ management services for member. 
• Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services. 
• Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description. 
• Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities. 
• Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan. 
• Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers). 
• Act as liaison and member advocate between the member/family, physician and facilities/agencies. 
• Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines. 
• Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues. 
• Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities. 
• Meets with clients in their homes, work-sites, physician’s or hospital to provide management of services. 
• Adapts to changes in policies, procedures, new techniques and additional responsibilities. 
• Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds. 
• Perform other duties as assigned. 

Additional Position Responsibilities – Optional 
• Travel to inpatient bedside, member’s home, provider’s office, hospitals, etc required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards. May require climbing multiple flights of stairs to a member's home, provider's office, etc. 


MINIMUM QUALIFICATIONS 
Education 
State the minimum required for the job 
Education Level Education Details Required/Preferred 
A Bachelor's Degree in Health Services or Nursing Required 
or equivalent work experience Required 

Work Experience 
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Experience Level Experience Details Required/Preferred 
2+ years of experience in clinical acute care, post acute care or home health care Required 
1+ year of experience in current case management Preferred 
Other Managed care experience Preferred 
Other Prior utilization management experience preferred in some geographic regions Preferred 
Other Experience in care of the elderly is required in some geographic regions Preferred 
Other Experience in home health, physicians office or public health Preferred 

Other Associates supporting Florida's Children’s Medical Services (CMS) must have a minimum of two (2) years’ experience in Pediatrics Required 

Licenses and Certifications 
List professional licenses and certifications associated with this job 
Licenses/Certifications Other Licenses/Certifications Required/Preferred 
Licensed Registered Nurse (RN) Required 
Other Maintain required contact hours to fulfill regulatory requirements Required 
Certified Case Manager (CCM) Preferred 

Skills 
State the minimum required for the job 
Skill Sets Other Skills Proficiency 
Ability to multi-task Intermediate 
Ability to work independently Intermediate 
Demonstrated time management and priority setting skills Intermediate 
Demonstrated interpersonal/verbal communication skills Intermediate 
Ability to create, review and interpret treatment plans Intermediate 
Ability to implement process improvements Intermediate 
Ability to effectively present information and respond to questions from families, members, and providers Intermediate 
Other Ability to understands the business and financial aspect of case mgmt in a managed care setting Intermediate 
Knowledge of healthcare delivery Intermediate 
Knowledge of community, state and federal laws and resources Intermediate 
Demonstrated written communication skills Intermediate 
Demonstrated customer service skills Intermediate 

Technology 
List technical skills associated with the job 
Technology Other Technology Proficiency Required/Preferred 
Microsoft Word Intermediate Required 
Microsoft Excel Intermediate Required 
Microsoft Outlook Intermediate Required 
Healthcare Management Systems (Generic) Intermediate Required 

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