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NJM Insurance Group logo
NJM Insurance Group

More Than 100 Years of Earning Trust

Care Manager II, Specialty Programs

ManagerManagerFull TimeRemoteSeniorTeam 1,001-5,000Since 1913H1B No SponsorCompany SiteLinkedIn

Location

New Jersey

Posted

78 days ago

Salary

$79.1K - $105.9K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Care Manager II, Specialty Programs

NJM Insurance Group

• 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.

Job Requirements

  • 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.

Benefits

  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement

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