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Care Manager - Long Term Care

Wellcare - Newark, NJ

Care Manager - Long Term Care','1701085','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at or view our videos at 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.','!*!Coordinates the care and services of Long Term Care members 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 PCP, member’s family, Supervisor/Manager of Care 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

Essential Functions:

In conjunction with the PCP, member, member’s family, and other pertinent members of the Interdisciplinary Care Team (IDT), CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member’s need for alternative services. Assesses short-term and long-term needs and establishes case management objectives.

Manages 75 to 100 active cases based on case intensity and acuity.

Responsible for Utilization Management and uses prescribed criteria to provide timely, appropriate, and medically necessary service authorizations.

Interacts continuously with member, family, physician(s), IDT members, and other providers, utilizing clinical knowledge and expertise to determine medical history and current status. Assesses the options for care, including use of benefits and community resources, in order to update the Person Centered Service Care Plan.

Acts as liaison and member advocate between the member/family, physician and facilities/agencies.

Maintains accurate records of care management activities in the EMMA system, using clinical guidelines.

Coordinates community resources with emphasis on medical, behavioral and social services. Applies care 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.

Participates in monthly chart audits.

Performs special projects as assigned. Additional Responsibilities:

','!*!Candidate Education:

Preferred A Bachelor's Degree in nursing or related field

Required A Bachelor's Degree in Nursing or related field may be required in certain states based on specific contracts 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 care/case management Candidate Skills:

Intermediate Ability to drive multiple projects a plus

Intermediate Ability to multi-task

Intermediate Ability to work in a fast paced environment with changing priorities

Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload

Intermediate Demonstrated time management and priority setting skills

Intermediate Ability to create, review and interpret treatment plans 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

Intermediate 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 Intermediate Microsoft Excel Intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express

Required Intermediate Microsoft Word

Required Intermediate Healthcare Management Systems (Generic)

Required Intermediate Microsoft Outlook Languages:

Preferred Other Bilingual skills

*LI-JP1','US-NJ-Newark','550 Broad Street','Suite 1200','Newark','07102','','Yes, 75 % of the Time','No','No','Care Manager - Long Term Care'

10 days 12 hours ago



Care Manager - Long Term Care Wellcare - Newark, NJ, United States


Location: Newark, NJ

Company Profile:
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.