Nurse Case Manager (RN / LPN)
Horizon Healthcare Staffing is seeking a Full time Case Manager, RN or LPN (Temp-Perm) to work within an insurance company that specializes in medical and disability management.
Location: Morganville NJ
Hours: Monday- Friday 8a-4p or 830a-430p
Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care. This Position requires good telephone skills, computer skills, working with Microsoft office (Outlook and Excel). The nurse will review medical records to determine criteria for absence from work. Communicate with employees, supervisors, and medical director.
Primary duties may include, but are not limited to:
- Ensures member access to services appropriate to their health needs.
- Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
- Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
- Coordinates internal and external resources to meet identified needs.
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Assists in problem solving with providers, claims or service issues.
- Requires BA/BS in a health-related field and minimum of 1 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Licensed and currently registered in the State of New Jersey with a current valid license in good standing as an RN or LPN issued by the NJ Board of Nursing