NJM Insurance Group

Care Manager II, Specialty Programs

NJM Insurance Group

full-time

Posted on:

Location Type: Remote

Location: New Jersey • United States

Visit company website

Explore more

✨ AI Apply
Apply

Salary

💰 $79,100 - $105,945 per year

About the role

  • 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.

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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
RN licenseBachelor's degree in social workBachelor's degree in health scienceBachelor's degree in behavioral scienceGraduate degree in Social WorkGraduate degree in Health and Behavioral Sciencecase management standards of practicemanaged care principlesspecialty population knowledgequality improvement processes
Soft Skills
organizational skillspresentation skillsmentorshipconstructive feedbackoral communicationwritten communicationproblem solvingconflict resolutiontraining facilitationteam collaboration
Certifications
RN license