NewarkRecruiter Since 2001
the smart solution for Newark jobs

Field Care Manager - RN - Newark

Company: Wellcare Health Plans
Location: Newark
Posted on: November 10, 2019

Job Description:

Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. 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 directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.REQUIRED: Active New Jersey Registered Nurse (RN) licenseReports to: Sr. Manager of Care ManagementDepartment: PHS - NJLocation: New JerseyEssential Functions:Evaluates members for case management services and determines appropriate level of care coordination/ management services for member.Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services.Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description.Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities.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.Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers).Act as liaison and member advocate between the member/family, physician and facilities/agencies.Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines.Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues.Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.Meets with clients in their homes, work-sites, physician's or hospital to provide management of services.Adapts to changes in policies, procedures, new techniques and additional responsibilities.Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds.Perform other duties as assigned. Additional Responsibilities:Travel to inpatient bedside, member's home, provider's office, hospitals, etc required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards. May require climbing multiple flights of stairs to a member's home, provider's office, etc.Candidate Education:Required A Bachelor's Degree in Health Services or NursingRequired or equivalent work experience Candidate Experience:Required 2 years of experience in clinical acute care, post acute care, home health care, or maternityPreferred 1 year of experience in current case managementPreferred Other Managed care experiencePreferred Other Prior utilization management experience preferred in some geographic regionsPreferred Other Experience in care of the elderly is required in some geographic regionsPreferred Other Experience in home health, physicians office or public healthRequired Other Associates supporting Florida's Children's Medical Services (CMS) must have a minimum of two (2) years' experience in Pediatrics.Required Other Work experience requirements may be waived for associates engaged in Florida's CMS contract that worked in a similar capacity for Florida's Department of Health in 2018. Candidate Skills:Intermediate Ability to multi-taskIntermediate Ability to work independentlyIntermediate Demonstrated time management and priority setting skillsIntermediate Demonstrated interpersonal/verbal communication skillsIntermediate Ability to create, review and interpret treatment plansIntermediate Ability to implement process improvementsIntermediate Ability to effectively present information and respond to questions from families, members, and providersIntermediate Other Ability to understands the business and financial aspect of case mgmt in a managed care settingIntermediate Knowledge of healthcare deliveryIntermediate Knowledge of community, state and federal laws and resourcesIntermediate Demonstrated written communication skillsIntermediate Demonstrated customer service skills Licenses and Certifications:A license in one of the following is required:Required Licensed Registered Nurse (RN)Required Other Maintain required contact hours to fulfill regulatory requirementsPreferred Certified Case Manager (CCM) Technical Skills:Required Intermediate Microsoft WordRequired Intermediate Microsoft ExcelRequired Intermediate Microsoft OutlookRequired Intermediate Healthcare Management Systems (Generic) Languages:Required Other In the state of NY, associates may be required to be proficient in one of two buckets of languages. Bucket one consists of the below:Required BengaliRequired Other Bucket two consists of:Required Other CantoneseRequired Other FujianeseAbout usHeadquartered 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 Health Plans, Newark , Field Care Manager - RN - Newark, Healthcare , Newark, New Jersey

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Licensed Clinical Psychologist
Description: br br Overview br br Licensed Psychologist br br White Plains, NY br br Join a leading APA-accredited, clinician-led behavioral health company today C.H.E. Behavioral Health Services (more...)
Company: CHE Behavioral Health Services
Location: White Plains
Posted on: 11/20/2019

Radiology Technologist Tech (Per Diem - Nassau)
Description: At GoHealth Urgent Care, we place the needs of our patients first - by providing an effortless patient experience, a welcoming culture of care and seamless integration with market-leading health systems (more...)
Company: GoHealth Urgent Care
Location: Levittown
Posted on: 11/20/2019

Licensed Practical Nurse (LPN)
Description: Licensed Practical Nurse LPN - 250 Sign On Bonus br br Now Offering Paid Time Off PTO Benefits br br Aveanna Healthcare, the largest pediatric home health care company in the U.S., is hiring (more...)
Company: Aveanna Healthcare
Location: Hackensack
Posted on: 11/20/2019


Nursing Director
Description: Full Time Registered Nurse - Program Operations Director At RestorixHealth, our mission is simple---to restore health and improve the quality of life As Program Operations Director, you are responsible (more...)
Company: Advantage Solution
Location: Mount Vernon
Posted on: 11/20/2019

Cath Lab RN Travel Nurse RN
Description: Nationwide Travel Nurse Jobs - Cath Lab RN Are you looking for a new nursing job Would you like to spend the season somewhere you've never been Hospitals nationwide are looking for qualified registered (more...)
Company: HealthCare Travelers
Location: Hicksville
Posted on: 11/20/2019

Nurse Practitioner
Description: Burke Rehabilitation Hospital located in White Plains NY, is looking to hire a 12-Hour Nurse Practitioner for the Night shift.Responsibilities:Provides primary care services
Company: Burke Rehabilitation Center
Location: White Plains
Posted on: 11/20/2019

Clinical Laboratory Technologist
Description: Generalist opening in Mount Vernon, New York. This and other medical lab technician jobs brought to you by AlliedHealthJobCafe.com Medical Technologist Needed: Brand Laboratory Space Ref: CO16New York, (more...)
Company: KA Recruiting Inc.
Location: Mount Vernon
Posted on: 11/20/2019

Traveling Registered Nurse
Description: Exciting travel positions are open for Registered Nurses with experience caring for patients for a 13 week contract assignment at a state-of-the-art area hospital.Enjoy a supportive, ambitious culture (more...)
Company: Jackson Nurse Professionals
Location: White Plains
Posted on: 11/20/2019

Licensed Practical Nurse LPN
Description: Towne Nursing is seeking full time and part time LPNs for placement at a long term care facility.
Company: Towne Nursing Staff
Location: White Plains
Posted on: 11/20/2019

Respiratory Therapist Reg - Full Time Night
Description: Respiratory Therapist Reg - Full Time Night br Req : 0000047146 br Category: Respiratory Therapy br Status: Full-Time br Shift: Night br Location: br Respiratory Care, 600 River Road, Lakewood, (more...)
Company: Barnabas Health
Location: Lakewood
Posted on: 11/20/2019

Log In or Create An Account

Get the latest New Jersey jobs by following @recnetNJ on Twitter!

Newark RSS job feeds