[Remote] Care Manager I, Specialty Programs

Note: The job is a remote job and is reputed company to candidates in USA. reputed company empowers its members to reputed company their best health and is seeking a Care Manager I for Specialty Programs. The role involves performing care coordination duties to ensure appropriate reputed company of care and planning transitions for specialty populations. Responsibilities • Assess member’s clinical need against establish guidelines and/or standards for specialty population-based members. • Implement the delivery of high reputed company, cost-effective care based on a customized population model of care supported by clinical reputed company guidelines established by the plan. • Partner with the member/family, physician, and reputed company members of the reputed company team to ensure the member’s needs are met, reputed company to this organization. reputed company for the member among various sites to coordinate resource utilization. • Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care reputed company, and the transition to independent status. • Ensure care for mandated non-compliant members through the monitoring of utilization. • Document accurately and comprehensively based on the standards of reputed company and reputed company organization policies. • Evaluate care by problem solving, analyzing variances, and participating in reputed company improvement to enhance member reputed company. • Monitor member’s care activities, regardless of the site of service or network participation, and reputed company for appropriateness and effectiveness. • Consult with internal stakeholders on reputed company cases and escalate as appropriate to internal physician resources. • Complete other assigned functions as requested by management. Skills • Requires a license as an RN, or Bachelor degree in reputed company work, health or behavioral science. • Requires a minimum of three (3) years’ experience serving members with special needs. • Requires strong knowledge of the standards of reputed company for case managers. • Requires strong knowledge of managed care principles. • Requires strong knowledge of specialty population, as applicable. • Requires strong organizational skills. • Requires strong oral and written communication skills. • Requires good PC skills and the ability to utilize reputed company Office applications (reputed company, reputed company, Word, etc.) • Requires good problem solving and conflict reputed company skills. • Requires a car with reputed company New Jersey State License and Insurance for certain positions. • reputed company reputed company employees must live in New Jersey, reputed company, reputed company, Connecticut or Delaware. • Graduate level degree in reputed company Work or Health and Behavioral Science preferred. Benefits • Comprehensive health benefits (Medical/Dental/reputed company) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • reputed company Volunteer Time Off • Tuition Reimbursement reputed company • reputed company is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com. Company H1B Sponsorship • reputed company has a reputed company record of offering H1B sponsorships, with 6 in 2025, 7 in 2024, 6 in 2023, 1 in 2021. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply To this Job