Registered Nurse Case Manager - Field in Bergen & surrounding counties, New Jersey
Core
Field Case Manager Registered Nurse developing and implementing health service strategies, policies, and programs to drive quality healthcare delivery for members enrolled in Managed Long-Term Services and Supports (MLTSS) and Dual Special Needs Programs.
Role type
Senior IC Registered Nurse Case Manager (Field)
Builds
Care plans, service authorizations, and interdisciplinary care coordination for medically complex and pediatric populations.
Domain
Healthcare / Long-Term Services and Supports (LTSS) / Managed Care
Deliverable
client delivery
Required skills
Advanced clinical judgment, critical thinking, care planning, utilization management, network management, cost-effective resource allocation, interdisciplinary collaboration, documentation, problem-solving, mentoring
Preferred skills
LTSS experience, case management, discharge planning, managed care, Medicaid/Medicare experience
Technologies
EHR portals, Microsoft Office Suite (Outlook, Word, Excel, SharePoint, Teams), VPN, multi-system navigation
Responsibilities
Conduct face-to-face home visits to evaluate medical needs and facilitate wellness; schedule and attend interdisciplinary meetings to advocate for safe discharge; develop care plans and authorize services within benefit limits; document accurately in electronic health records; coordinate care with members, PCPs, and care teams; mentor new hires.
Seniority
Senior, hands-on IC with field travel