Case Manager – Patient Relations (Home Care Agency)

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.

Qualifications

• Bachelor’s degree in Nursing, Social Work, or Health Care Administration required; Master’s preferred.
• Active RN in 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 driver’s license and reliable transportation required.

Preferred Experience

• Prior employment with a major NJ MCO (Horizon, Amerigroup/Wellpoint, UnitedHealthcare, Fidelis, Aetna).

Compensation & Benefits

• Competitive salary based on experience.
• Health, dental, and vision insurance.
• Paid time off and holidays.
• Mileage reimbursement.
• Ongoing training and career development opportunities.