Responsibilities:

• Conduct high-level assessment and planning for selected population-based members.
• Collaborate with the member/family, physician, and all members of the healthcare team.
• Coordinate the delivery of high-quality, cost-effective care based on a customized population model of care.
• Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Utilize the care management process to set priorities, plan, organize, and implement interventions.
• Encourage member participation and compliance in the care management program efforts.
• Document accurately and comprehensively based on the standards of practice and current organization policies.
• Interact and communicate telephonically, striving for continuity and efficiency as the member is managed along the continuum of care.
• Evaluate care by problem-solving, analyzing variances, and participating in the quality improvement program.

Education Qualification:

• Prefers a bachelor’s degree.
• Requires a minimum of two years of business experience, preferably in a medical support related position or health insurance environment.
• For RN’s/LPN’s, requires an active unrestricted NJ RN/LPN License or active Compact License.
• For Social Workers, requires an unrestricted New Jersey Certified Social Worker (CSW). Prefers current New Jersey License Social Worker (V) or License Clinical Social Worker (LCSW).