Care Manager - Long Term CareWellcare - Newark, NJ
Care Manager - Long Term Care','1803992','Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune World's Most Admired Company, ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.','!*!Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the Supervisor / Manager of Case Management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the Member.
Department: Long Term Care
Reports to: Mgr, Care Management
In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establishes case management objectives.
Manages 60 to 80 active cases based on case intensity and acuity. Specialty Case Manager case loads may vary.
Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
Maintains accurate records of case management activities in the EMMA System using clinical guidelines.
Coordinates community resources with emphasis on medical, behavioral and social services. Applies case management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.
Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
Schedules or facilitates scheduling appointments and follow-up services
Requests consultation and diagnostic reports from network specialists.
Contacts members to remind them about upcoming appointments and/or missed appointments.
Participates in monthly chart audits.
Performs special projects as assigned. Additional Responsibilities:
Case load may differ by state and/or location based on contract requirements, membership, plan and/or operational best practice.
Some states and/or locations may require nurses to occasionally travel to facility or inpatient bedside to conduct assessments or face to face visits.
Specific state specialty programs may require initial and annual training hours related to the area of specialty. ','!*!Candidate Education:
Required A High School or GED
Preferred A Bachelor's Degree in nursing or related field
Required Other Illinois's Children with High Needs program requires a bachelor's degree in nursing, social sciences, social work or related field. Candidate Experience:
Required 2 years of experience in a clinical acute care position(s), preferably in home health, physicians office or public health
Required 1 year of experience in current case management experience Candidate Skills:
Intermediate Ability to drive multiple projects
Intermediate Ability to multi-task
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Ability to work independently
Intermediate Demonstrated time management and priority setting skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to create, review and interpret treatment plans
Intermediate Demonstrated negotiation skills
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Ability to effectively present information and respond to questions from peers and management
Intermediate Ability to implement process improvements Licenses and Certifications:A license in one of the following is required:
Required Licensed Registered Nurse (RN)
Preferred Certified Case Manager (CCM) Technical Skills:
Required Beginner Microsoft Excel
Required Beginner Microsoft Word
Required Beginner Healthcare Management Systems (Generic)
Required Beginner Microsoft Outlook Languages:
Preferred Other Bilingual skills ','US-NJ-Newark','550 Broad Street','Suite 1200','Newark','07102','','','No','No','Care Manager - Long Term Care
20 days 9 hours ago
applyCare Manager - Long Term Care Wellcare - Newark, NJ, United States
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.
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