DSNP Care Specialist III

DSNP Care Specialist III

Requirements

• High School Diploma/GED required.
• Bachelor’s degree preferred or relevant experience in lieu of degree.
• Requires a minimum of three (3) years broad clinical experience.
• Requires a minimum of two (2) years experience in home care, discharge planning and/or case management.
• Requires a minimum of three (3) years experience in the managed care industry.
• Active Unrestricted NJ SW License or New Jersey Certified Social Worker (CSW) or New Jersey License Social Worker (LSW) or License Clinical Social Worker (LCSW) preferred.
• Prefers CCM certification.
• Requires a car with valid New Jersey State License and Insurance for certain positions.

Responsibilities

• Conducts high-level assessment and planning for selected population-based members.
• Collaborates with the member/family, physician and all members of the healthcare team, internal and external to this organization.
• Coordinates the delivery of high quality, cost-effective care based on a customized population.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Interacts with the member/family, physician and healthcare team. Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care outcomes, and the transition to independent status.
• Encourages member participation and compliance in the care management program efforts.
• Utilizes population-based case management process for goal directed member/family care.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Interacts and communicates, either telephonically and/or on site striving for continuity and efficiency as the member is managed along the continuum of care.
• Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Provides telephonic and/or field based population case management activities specific to the care management program.
• Provides guidance and support to less experienced Care Specialists.

Preferred Qualifications

• Strong knowledge of the standards of practice for case managers.
• Strong knowledge of managed care principles and concepts including Health Plan Employer Data and Information Sheet (HEDIS).
• Strong organizational skills.
• Strong oral and written communication skills.
• Good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Good problem solving and conflict resolution skills.
• Good presentation skills.
• Project Management Skills.
• Acts as mentor / preceptor to new hires within the department.
• Performs user acceptance testing on any process, program and system changes or enhancements, as indicated by leadership.
• Contributes to overall program execution and success, which includes; active participation in strategic and tactical planning, identifying process improvements as well as creating, developing and implementing revisions.