Care Specialist III, Field (Field Based - Passaic County)

Horizon Healthcare Services•Hopewell, NJ

4d•Onsite

About The Position

This field-based position is accountable for assessing and managing members’ cases to facilitate health care services. The Care Specialist coordinates high-quality, cost-effective care in line with member needs, the program model, and the plan’s clinical practice guidelines. The role involves member and family advocacy, collaboration with physicians and internal and external health care teams, and field-based and/or telephonic case management. Daily local travel is required, and on-call work may be required for the managed long-term support and services case management program. The position uses the care management process to assess needs, establish priorities and goals, plan and implement interventions, encourage member participation, and evaluate outcomes. It also includes accurate documentation, resource coordination, problem solving, and participation in quality improvement activities. Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Requirements

Bachelor’s degree in a health-related or behavioral science field.
Three to four years of broad clinical experience.
At least three years of experience in home care, discharge planning, or case management.
At least two years of experience in the managed care industry.
Strong knowledge of care manager standards of practice.
Ability to interview and assess members.
Knowledge of caseload management and casework practices.
Knowledge of human services principles for determining member eligibility for benefits and services.
Ability to solve problems effectively and locate community resources.
Knowledge of needs and service delivery systems for populations in the Care Manager’s caseload.
Strong organizational skills.
Strong oral and written communication skills.
Good PC skills and ability to use Microsoft Office applications, including Excel, Access, and Word.
Good problem-solving and conflict-resolution skills.
Good presentation skills.
Ability to work with limited daily supervision.
Daily local travel is required; possible on-call work for the managed long-term support and services case management program.
Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Nice To Haves

Experience with the elderly frail population is preferred.
Active, unrestricted New Jersey social work license preferred; candidates with a restricted license will not be considered.
Strong knowledge of managed care principles and concepts preferred.

Responsibilities

Assist with implementation and facilitation of services to members in the program.
Collaborate with members and families, physicians, and internal and external health care team members.
Coordinate delivery of high-quality, cost-effective care based on members’ needs, the program model, and plan clinical practice guidelines.
Advocate for members and families across care settings to coordinate resource utilization and evaluate services provided.
Use the care management process to set priorities, plan, organize, and implement goal-directed interventions.
Encourage member participation and compliance in case management program efforts.
Document accurately and comprehensively according to standards of practice and organizational policies.
Communicate effectively with members during face-to-face and/or telephonic contact.
Consider fiscal accountability and resource utilization while supporting optimal self-care outcomes.
Evaluate care, solve problems, analyze variances, and participate in quality improvement to enhance member outcomes.
Provide field-based and/or telephonic case management activities specific to the case management program.
Perform duties as assigned by management.