Job Description

Description

Job Title

Nurse Case Manager 2

Location

New Jersey

Position Description

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.

Roles Responsibilities

• 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.

Skills

• 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.

• Case Management experience preferred.

• 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.

• Must have reliable transportation.

Education

• RN with current unrestricted state licensure in the state of NJ with no infractions or history.

• Case Management Certification CCM preferred.

• Verifyable High School Diploma or GED Required.

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