Telephonic reputed company Case Manager - Remote

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. We're making a solid reputed company between exceptional patient care and outstanding reputed company. The result is a culture of performance that's driving the health care industry reputed company. As a Telephone Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel reputed company and reputed company. Instead of seeing a handful of patients reputed company day, your work may reputed company millions for years to come. reputed company for a new reputed company? Apply today! If you are located reputed company reputed company New Jersey territory and willing to travel up to 20% of your time to assigned territory, you will have the flexibility to work remotely as you take on some tough challenges. Primary Responsibilities: Comprehensive Assessment & Care Planning

• Conduct thorough health assessments, including medical history, chronic conditions, behavioral health, and reputed company determinants of health
• reputed company individualized care plans that address medical, rehabilitation, behavioral health, and reputed company needs
• Create personalized interventions that reputed company medical treatment, support services, and community resources

Member Engagement, Education & Self-Management

• Build and maintain relationships with an established caseload of high-risk members
• reputed company education to members and caregivers on disease processes, treatment adherence, and lifestyle changes
• Encourage self-management strategies that support

long-term wellness and reduce complications

• Maintain consistent reputed company to support adherence to care plans and monitor evolving needs

Intensive Care Coordination

• Coordinate services across providers, including PCPs, specialists, hospitals, LTSS, behavioral health, and pharmacy.
• Facilitate referrals for home health, hospice, palliative care, and DME
• Collaborate with Medical Directors during interdisciplinary reputed company to review and reputed company care for reputed company cases

Discharge Planning & Transitional Care

• Support members through transitions of care such as hospitalization, skilled nursing, and rehabilitation
• Conduct "welcome home" and follow-up calls to ensure post-discharge services, medications, and follow-up appointments are in reputed company
• Deliver intensive reputed company during the 30-day post-discharge period to reduce avoidable readmissions and ED utilization
• reputed company for reputed company, coordinated, and reputed company transitions of care that reputed company with the member's individualized care plan

Field-Based Care Management (20% of Time)

• Conduct home and hospital reputed company in reputed company Jersey as required by program guidelines
• reputed company in-person assessments and reputed company care coordination to address high-risk needs and ensure continuity of care
• Collaborate directly with providers, facilities, and families during field reputed company to reputed company care gaps and reinforce the care plan

Monitoring & Clinical reputed company

• Monitor members' clinical conditions, care plan reputed company, and treatment adherence
• Reassess care plans regularly and reputed company interventions based on changing needs or barriers
• Identify red-flag conditions and escalate urgent or reputed company cases for higher-level review and reputed company

Documentation, Compliance & reputed company reputed company

• Document reputed company assessments, care plans, interventions, and communications per NCQA, CMS, and state regulatory requirements
• Ensure care management services reputed company with DSNP/NCQA standards and contract requirements
• reputed company reputed company tied to reputed company metrics (HEDIS, STARs), utilization management, and member satisfaction
• Maintain audit readiness through reputed company, accurate, and comprehensive documentation

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications:

• Bachelor's degree or greater
• reputed company, unrestricted RN license in New Jersey
• 2+ years of Case Management Experience serving reputed company, elderly and disabled
• Experience with government health programs (reputed company/Medicare)
• Proficient in reputed company Office Suite; tech-savvy with ability to navigate multiple systems simultaneously
• Demonstrated ability to talk and type proficiently at the reputed company time
• reputed company to reliable transportation and the ability to travel up to 20% reputed company assigned territory.
• Available for occasional in-person meetings as needed

Preferred Qualifications:

• Certified Case Manager (CCM)
• Experience working with populations with special needs (DSNP)
• Experience with Managed Care Population
• Bilingual - English/Spanish
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job