RN Case Manager, Military & Family Support Services

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

📋 Description

• Evaluate favorable and partially favorable determinations in line with relevant regulations.

• Make medical necessity determinations for assigned Medicare State East cases.

• Address technical challenges within assigned Medicare reconsideration cases.

• Analyze cases, summarize facts, and evaluate the issues involved.

• Execute general legal or medical research, draft sections of proposals, or serve as a project liaison as necessary.

• Act as the Subject Matter Expert (SME) for the project.

• Organize services, patient care, and documentation processes for service members and their families.

• Serve as a liaison between military and civilian medical and non-medical agencies to ensure continuity of care.

• Conduct assessments, care planning, and evaluations to foster optimal health and facilitate successful transitions back to duty or into civilian life.

• Undertake other tasks as assigned by management.

⛳️ Requirements

• Current RN license.

• At least a two-year nursing degree from an accredited institution.

• Minimum of 2 years of nursing and/or case management experience.

• Bachelor's degree with 5–7 years of experience in consulting within the designated function.

• Advanced degree is preferred.

• Certification as a case manager from a recognized certifying body, or the ability to obtain certification within one year of hire.

• Active secret clearance at a minimum.

• Proven ability to comprehend diagnoses and enhance client function and self-care.

• Familiarity with client education principles and complex medical, psychosocial, and financial problem-solving.

• Understanding of VA/DoW Clinical Practice Guidelines.

• Knowledge of the healthcare financial environment and population-health fiscal stewardship.

• Proficiency in research tools for critically assessing practices, opportunities, and outcomes.

• Awareness of pharmaceuticals, including their effects, side effects, and complications.

• Understanding of community resources, client entitlements, and benefit eligibility.

• Capability to utilize utilization review criteria and identify quality and risk-management issues.

• Proficiency in using information systems, technology, computers, and software for data collection, tracking, trending, analysis, and presentations.

• Strong professional oral and written communication skills.

• Team coordination, facilitation, and communication abilities.

• Reliable high-speed internet connection.

• Minimum download speed of 20 Mbps, or 50 Mbps for shared internet connectivity.

• Minimum upload speed of 5 Mbps.

• Preferred: Master's degree in Social Work (MSW).

• Preferred: Licensed Clinical Social Worker (LCSW) licensure.

🏝️ Benefits

• Flexibility tailored to support work/life balance.

• Medical, Dental, Vision, and Prescription plans available.

• Partially funded Health Savings Account (HSA).

• Life Insurance coverage.

• Discounts on Auto, Home, Renters, and Pet Insurance.

• 401(k) Retirement Savings Plan with Company Match.

• Paid Time Off (PTO).

• Paid holidays.

• Extended sick leave.

• Short- and Long-Term Disability coverage.

• Employee Assistance Program (EAP).

• Employee recognition platform.

• Opportunities for Tuition Reimbursement.

• Employee discounts and additional exclusive benefits.

• Wellness programs and resources offered.

• Access to training programs, workshops, conferences, and ongoing learning opportunities.

• Maximus covers costs related to renewing necessary licenses and certifications.

• Provision of company-issued computer equipment.