Case Management, Certified Case Manager (CCM), Clinical Information, Compensation and Benefits, Corporate Policies, Cost Control, Maintain Compliance, Quality Management, Registered Nurse (RN), Regulations, Regulatory Compliance, Team Player
Position Summary: The Case Manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with an unrestricted active license in NJ (compact licensure). Northern or Central Counties considered (Monmouth, Morris, Somerset, Union, Passaic, Bergen, Essex) Duties
- Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
- Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.