Responsibilities:

• Assess patient's clinical needs against established guidelines to ensure services provided are medically appropriate.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in implementing services to meet members' needs.
• Coordinate with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.
• Coordinate the delivery of high-quality, cost-effective care supported by clinical practice guidelines.
• Monitor patient's medical care activities for appropriateness and effectiveness.
• Advocate for members/families to coordinate resource utilization and service evaluation.
• Refer members to MLTSS when appropriate.
• Educate members on the availability of SNP if appropriate.
• Document accurately and comprehensively based on standards of practice.
• Interact and communicate with multidisciplinary teams for continuity and efficiency in care management.
• Understand fiscal accountability and its impact on resource utilization.
• Evaluate care, analyze variances, and participate in quality improvement programs.
• Complete other assigned functions as requested.
• Perform duties as assigned by management.

Education Qualification:

• Must be a Registered Nurse (RN).

Required Skills:

• Valid Driver's License required.
• Ability to work independently and be a self-starter.
• Organized, tech-savvy, and proficient in computer skills.
• Excellent at taking detailed notes.
• Willingness to travel for assessments in the North NJ area.
• Training at the Hopewell location for the first two weeks.
• Reimbursement for mileage available.

Payrange - 35$/hr. to 40$/hr.