Market leading managed care organization looking for hybrid RN Case Managers! Great opportunity, please call us today!
Please note, must have active NJ RN licensure for this role. Location: Hybrid-working remotely and traveling locally 25-50% of the time in Camden, Gloucester, Atlantic or Cumberland Counties, New Jersey (will be reimbursed for mileage). Schedule: Monday-Friday, 8:00 AM-5:00 PM EST Contract Length: 6-month contract with potential for long term based on performance and business needs. Position Summary The RN Case Manager utilizes a collaborative process of assessment, planning, facilitation, care coordination, and advocacy to help members access appropriate healthcare services and resources. Through comprehensive telephonic assessments and clinical review, the Case Manager develops individualized care plans, coordinates services, and promotes optimal, cost-effective health outcomes. This position requires strong clinical judgment, critical thinking, and the ability to work independently in a fully remote environment. Key Responsibilities Conduct comprehensive telephonic assessments using standardized clinical assessment tools for members enrolled in Managed Long-Term Services and Supports (MLTSS). Assess members' medical needs, eligibility, and benefit plans to determine appropriate services and referrals, including: Adult Medical Day Care Pediatric Medical Day Care Personal Care Assistant (PCA) Services Nursing Facility Custodial Care Personal Preference Program (PPP) MLTSS Enrollment Utilize clinical tools, member information, and data review to evaluate healthcare needs and identify appropriate internal and external resources. Develop individualized, cost-effective care plans that support members' health goals. Coordinate care with members, authorized representatives, primary care providers, specialists, and interdisciplinary care teams. Schedule and participate in interdisciplinary care meetings to support safe transitions and continuity of care. Apply established clinical criteria, case management guidelines, regulatory requirements, and company policies when making care management decisions. Advocate for members to ensure timely access to medically appropriate services. Work with diverse populations, including pediatric and medically complex members. Maintain accurate, timely documentation within the electronic health record. Utilize critical thinking and problem-solving skills to support effective case resolution. Follow case management and quality management processes in compliance with regulatory and accreditation standards. Mentor new team members after achieving proficiency in the role. Required Qualifications Active, unrestricted Registered Nurse (RN) license in the State of NJ. Associate degree in Nursing or higher. Minimum of 3 years of clinical experience in a hospital, home health, ambulatory care, or similar clinical setting. Strong assessment, documentation, and care coordination skills. Ability to work independently in a remote environment. Preferred Qualifications Case management and/or discharge planning experience. Managed care experience. Crisis intervention experience. Case Management Certification (CCM). Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com....customers, ranging from leading AI companies like the major LLM labs, Decagon, and Glean to large enterprises like Snowflake, Workday, and Intel. Weve built products customers love and a sales motion that works. Now, we need to pour fuel on it. That's why we're looking...
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