Healthcare Case Manager Location: Remote (Eligible in Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming) Schedule: Monday-Friday, 8:00 AM - 5:00 PM Employment Type: Full-Time (Contract; potential for conversion)

About the Role

We are seeking a compassionate and detail-oriented Case Manager to join our multidisciplinary team. In this role, you will coordinate care, services, and resources to improve health outcomes for members, particularly those with complex needs. You will work collaboratively with members, families, providers, and internal partners to ensure effective care planning and delivery across the healthcare continuum.

Key Responsibilities

• Collaborate as part of a multidisciplinary team to coordinate care and services for members
• Conduct comprehensive assessments to evaluate member needs and develop effective care plans
• Create and implement member-centered care plans based on health status, education level, and support systems
• Identify barriers to care and proactively address gaps to improve outcomes
• Connect members to community resources and funding sources to support care plans
• Monitor member progress through ongoing outreach, follow-ups, and care plan adjustments
• Facilitate care across the continuum (e.g., physician offices, hospitals, rehabilitation, skilled nursing, home care)
• Educate members to encourage proactive health management and improved outcomes
• Maintain thorough and accurate documentation of assessments, care plans, and outcomes
• Conduct outreach to high-risk, high-cost, or high-utilization members as needed
• Review treatment plans and assess benefit eligibility, including potential exceptions or flex options
• Evaluate medical necessity and appropriateness of services
• Support development of policies, procedures, and training materials as needed

Minimum Qualifications

• Active licensure as one of the following:
• Registered Nurse (RN)
• Registered Dietitian (RD)
• Licensed Clinical Social Worker (LCSW)
• Minimum 3 years of clinical and/or case management experience
• Valid and active clinical license in North Carolina or compact multistate license
• For some roles:
• Master's in Social Work with 5+ years of relevant experience may be considered
• Must obtain applicable certifications (e.g., CCM, CDCES) within 2 years if required

Compensation

Salary Range: $65,000 - $75,000 with company subsidized medical, dental, and vision benefits