Field Care Manager
Posted on: January 16, 2020
Do your best work. Live your best life. If you thrive in a
fast-paced, growth-oriented environment, WellCare is the place for
you. Our clinicians have the ability to guide, educate and support
members facing a diverse set of health challenges. You will gain
valuable experience as you positively affect the lives you touch
every day. As a clinical professional on the WellCare team, you
will enjoy many advantages, including competitive salaries,
generous benefits, job stability, continuing education and all the
resources you need to advance in your career.
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.
Reports to: Manager of Care Management
Location: New Jersey
--- 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
--- Requests consultation and diagnostic reports from network
--- Contacts members to remind them about upcoming appointments
and/or missed appointments.
--- Participates in monthly chart audits.
--- Performs special projects as assigned.
--- Case load may differ by state and/or location based on contract
requirements, membership, plan and/or operational best
--- 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.
--- 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.
--- Required 2 years of experience in a clinical acute care
position(s), preferably in home health, physicians office or public
--- Required 1 year of experience in current case management
--- Intermediate Ability to drive multiple projects
--- Intermediate Ability to multi-task
--- Intermediate Ability to work in a fast paced environment with
--- Intermediate Ability to work independently
--- Intermediate Demonstrated time management and priority setting
--- Intermediate Demonstrated interpersonal/verbal communication
--- Intermediate Ability to create, review and interpret treatment
--- 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)
--- Required Beginner Microsoft Excel
--- Required Beginner Microsoft Word
--- Required Beginner Healthcare Management Systems (Generic)
--- Required Beginner Microsoft Outlook
--- Preferred Other Bilingual skills
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE:
WCG) focuses primarily on providing government-sponsored managed
care services to families, children, seniors and individuals with
complex medical needs primarily through Medicaid, Medicare
Advantage and Medicare Prescription Drug Plans, as well as
individuals in the Health Insurance Marketplace. WellCare serves
approximately 5.5 million members nationwide as of September 30,
2018. WellCare is a Fortune 500 company that employs nearly 12,000
associates across the country and was ranked a "World's Most
Admired Company" in 2018 by Fortune magazine. 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, creed, age, sex, pregnancy, veteran status, marital
status, sexual orientation, gender identity or expression, national
origin, ancestry, disability, genetic information, childbirth or
related medical condition or other legally protected basis
protected by applicable federal or state law except where a bona
fide occupational qualification applies. Comprehensive Health
Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Keywords: WellCare, Newark , Field Care Manager, Executive , Newark, New Jersey
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