Case Manager

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Oversee members with intricate health requirements throughout the spectrum of case management services

• Perform telephonic clinical evaluations to address the health and wellness needs of members

• Assist members with chronic and complex conditions through education, coaching, resources, and interventions

• Create case-specific or condition-specific care plans utilizing the clinical information system

• Set both short- and long-term health objectives

• Maintain consistent telephonic communication with members to monitor progress and reassess needs

• Adjust care plans as necessary

• Communicate with treating providers in complex clinical scenarios

• Offer education, consultation, and training to other clinical teams

• Identify online, telephonic, and community resources and facilitate member access to these services

• Educate members on health conditions, self-management, preventive care, lifestyle enhancements, and healthcare resources

• Integrate preventive health services and lifestyle improvement opportunities into interactions with members

• Precisely document activities in accordance with business processes, regulatory standards, and accreditation requirements

• Aid with appeals/denials, provider inquiries, claims processing, and interpretation of benefit information

• Coordinate specialized services such as transplant facilities and other member support programs

• Carry out additional duties as assigned

⛳️ Requirements

• Must possess a current, active Registered Nurse (RN) license in Pennsylvania

• Must live in Pennsylvania to work remotely

• US Citizenship is required

• 5+ years of pertinent healthcare/case management experience

• Experience in Disease Management is required

• Strong clinical assessment skills, particularly in care coordination and member education

• Previous Case Management experience

• Experience in Managed Care environments

• Experience with Medicaid populations is highly preferred

• Preferred experience in Telephonic Case Management / telephonic outreach

• Experience in developing and managing customized care plans

• Experience in identifying and coordinating community resources

• Knowledge of preventive health services and chronic disease management

• Experience with a 1-800/member service line is preferred

• Strong skills in clinical assessment and care coordination

• Excellent verbal and written communication abilities

• Strong skills in member education and motivational interviewing

• Ability to work independently while effectively managing time and caseloads

• Strong organizational and documentation capabilities

• Compassionate and professional demeanor when working with members

• Strong understanding of chronic disease management and health promotion

• Excellent work ethic and ability to function effectively in a remote setting

• Must complete the Care Manager Assessment

• Certified Case Manager (CCM) certification is preferred

🏝️ Benefits

• Contract duration: 6 months

• Remote work opportunity for candidates living in Pennsylvania

• Immediate start date