RN Case Manager - Medicaid/NJ FamilyCare
RN Case Manager - Medicaid/NJ FamilyCare
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Location:New Jersey (travel to client homes and community providers as needed)
About Us
We are a growing home care agency dedicated to delivering compassionate high-quality care for seniors and individuals. Our mission is to ensure that each client receives the support advocacy and resources necessary to thrive in the home and community.
Position Summary
The Case Manager Patient Relations will serve as the primary liaison between patients families physicians and managed care organizations (MCOs). This role ensures that clients receive coordinated cost-effective and patient-centered care in alignment with clinical best practices and payer requirements.
Key Responsibilities
- Conduct comprehensive assessments of clients medical social and behavioral needs.
- Develop and implement individualized care plans that support safe effective and culturally appropriate home care.
- Act as the primary point of contact for patients and families ensuring their concerns and preferences are addressed.
- Coordinate services with physicians hospitals community agencies and managed care organizations (Horizon UnitedHealthcare Fidelis Wellpoint Aetna).
- Advocate for patients by navigating benefits resolving escalations and connecting them to community resources.
- Monitor care delivery track patient outcomes and adjust care plans as needed.
- Ensure compliance with Medicaid/NJ FamilyCare requirements agency policies and regulatory standards.
- Maintain accurate timely documentation in agency records and MCO systems.
- Bachelors degree in Nursing Social Work or Health Care Administration required; Masters preferred.
- Active RNin New Jersey strongly preferred.
- 3 years of case management or care coordination experience in home care hospital MCO or community health setting.
- Knowledge of NJ Medicaid NJ FamilyCare and managed care practices.
- Strong communication and advocacy skills with a patient-first mindset.
- Ability to work independently while collaborating across clinical and administrative teams.
- Valid drivers license and reliable transportation required.
- Prior employment with a major NJ MCO (Horizon Amerigroup/Wellpoint UnitedHealthcare Fidelis Aetna).
- Competitive salary based on experience.
- Health dental and vision insurance.
- Paid time off and holidays.
- Mileage reimbursement.
- Ongoing training and career development opportunities.
Required Experience:
Manager
Employment Type
Full Time
