Responsible for performing care manager duties using established guidelines to ensure appropriate level of care for our members
Coordinate the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care
Evaluate the appropriateness and efficiency of all services designed to meet the member’s needs
Coordinates and assists in implementation of care plan for members
Act as subject matter expert for respective area for mentoring/ preceptor /training/remediation classes
Conduct training and presentations in team meetings and facilitate ad-hoc training activities
Participate in department workgroups to drive internal process changes and efficiencies
Provide reports and feedback on mentees progress to assigned Supervisor as part of the orientation process; assist in the development of plan to identify opportunities for improvement
Act as a subject matter expert and participate in user acceptance testing for medical management system
Evaluates care management processes by problem solving, analyzing variances, and participating in the quality improvement program to enhance trained staff outcomes
Participate in audit activities including IPRO, NCQA, or any other ad-hoc state audits.

Requires a license as an RN, or Bachelor degrees in social work, health or behavioral science
Graduate level degree in Social Work or Health and Behavioral Science preferred
Requires a minimum of five (5) years’ experience working with special needs
Requires strong knowledge of the standards of practice for case managers
Requires strong knowledge of managed care principles
Requires advanced knowledge of specialty population, as applicable
Requires strong organizational skills
Requires presentation skills and ability to conduct trainings to teams
Requires the ability to provide constructive feedback and mentorship to team members
Requires strong oral and written communication skills
Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)
Requires good problem solving and conflict resolution skills
Requires a car with valid New Jersey State License and Insurance for certain positions.

Care Manager II, Specialty Programs

Key skills