DSNP Care Manager: Dual-Special Needs Case Leader

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 63,000 - 84,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Dual Special Needs Case Manager in New Jersey to assess clinical needs, develop care plans and coordinate services across the continuum of care.

You will evaluate service necessity and efficiency, monitor outcomes, and advocate for patients with families, providers and facilities, both in-field and by phone. A strong clinical background and NJ licensing are required.

Qualifications

• Requires a minimum of three (3) years' broad clinical experience.
• Requires a minimum of three (3) years' experience in the health care delivery system/industry.

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 current organization policies.
• Provides field based and/or telephonic case management activities specific to the Dual Special Needs program.

Skills

Organizational skills

Communication skills

Microsoft Office

Problem solving

Presentation skills

Independent work

Education

High School Diploma/GED

Bachelor degree preferred

Active NJ license or CSW

Tools

Microsoft Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Dual Special Needs Case Manager in New Jersey to assess clinical needs, develop care plans and coordinate services across the continuum of care.

You will evaluate service necessity and efficiency, monitor outcomes, and advocate for patients with families, providers and facilities, both in-field and by phone. A strong clinical background and NJ licensing are required.