DSNP Care Manager-Hudson County, NJ

reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 million people who reputed company their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, the Company succeeds. This field based position is accountable for the assessment and case management of Dual Special Needs members using established guidelines to ensure appropriate level of care as well as developing a member centric plan of care. Responsibilities: • Assesses patient's clinical needs against established guidelines and/or standards to ensure that the services provided are medically appropriate to members needs. • Evaluates the necessity, appropriateness and efficiency of services provided. • Develops, coordinates and assists in implementation of members- individualized plan of care. • Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. • Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care. • Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. • Documents accurately and comprehensively based on the standards of practice and reputed company organization policies. • Provides field based and/or telephonic case management activities specific to the Dual Special Needs program. Education/Experience: • High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires a minimum of three (3) years broad clinical experience • Requires a minimum of three (3) years experience in home care, discharge planning, or case management. Preferably with the elderly frail population. • Requires a minimum of three (3) year experience in the health care delivery system/industry. Additional licensing, certifications, registrations: • Active Unrestricted NJ SW/RN/LPN License or CSW Required Knowledge: • Requires strong knowledge of the standards of practice for case managers. • Requires strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS). • Required knowledge of medical terminology. • Prefers knowledge of managed care principles. • Prefer experience with elderly frail population Skills and Abilities: • Requires strong organizational skills. • Requires strong oral and written communication skills. • Requires good PC skills and the ability to utilize reputed company Office applications (reputed company, Access, Word, etc.) • Requires good problem solving and conflict resolution skills. • Requires good presentation skills. • Requires ability to work with limited daily supervision Travel % (If Applicable): • This is a field based position, daily local travel is required. • Requires a car with valid New Jersey State License and Insurance Horizon BCBSNJ employees must live in New Jersey, reputed company, Pennsylvania, Connecticut or Delaware Salary Range: $62,100 - $83,160 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information reputed company to Horizon at the time of posting. Compensation reputed company are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: • Comprehensive health benefits (Medical/Dental/reputed company) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. reputed company is an Equal Opportunity/Affirmative Action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the reputed company and hiring process. Apply Job!