Medical Case Manager

Manage a caseload of members with moderate-complexity health needs Assess members’ health status, needs, and available resources Develop individualized care plans with members, physicians, and healthcare providers Implement and coordinate care plans and access to appropriate services and resources Coordinate referrals to specialists and community resources Monitor member progress and adjust care plans as needed Evaluate the effectiveness of interventions and services Advocate and act as a liaison to meet members’ individual healthcare needs Promote quality, cost-effective outcomes in accordance with contract benefits Collaborate and communicate with physicians, providers, co-workers, and healthcare team members Document activities in compliance with business processes, company policies, regulatory requirements, and accreditation standards Identify potential cost savings, quality improvements, and workflow efficiencies Perform other duties as assigned or requested Requirements 3 years of experience in any combination of clinical, case/utilization management, disease condition management, provider operations, and/or health insurance experience with RN licensure or a Master’s degree 5 years’ experience with a Bachelor’s in Social Work Bachelor’s degree in nursing or RN licensure or Master’s degree in Social Work, Counseling, or related field, OR Bachelor’s degree in Social Work Required professional license/certification: LSW, LPC, LBSW, LCSW, LMSW, LGSW, LCSW, or current State RN licensure, or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Strong assessment and care planning skills Ability to work independently and as part of a team Proficiency in Microsoft Office Suite, case management software, and electronic health records Understanding of healthcare systems and case management principles Bilingual English/Spanish language skills preferred Telephonic experience preferred Medicaid managed care and/or Medicare experience preferred Experience working with the healthcare needs of diverse populations preferred Experience demonstrating understanding of cultural competency preferred Certified Case Manager (CCM) preferred Must comply with HIPAA, data security guidelines, company policies, legal requirements, and accreditation standards Core Competencies Demonstrates strong assessment and care planning skills while managing a caseload of members with moderate-complexity health needs. Proficient in coordinating care plans, collaborating with healthcare teams, and ensuring compliance with regulatory requirements. Highest-signal resume keywords RN Licensure Case Management Software Assessment Skills Care Planning Bilingual English/Spanish ATS Optimization Keywords Hard Skills Care Coordination Health Needs Assessment Individualized Care Plans Monitoring Member Progress Evaluating Interventions Cost Savings Identification Cultural Competency Telephonic Experience Medicaid Managed Care Medicare Experience Soft Skills Team Collaboration Independent Work Advocacy Certifications & Qualifications Certified Case Manager (CCM) LSW LPC LBSW LCSW LMSW LGSW Industry Keywords Healthcare Systems Case Management Principles Regulatory Compliance Accreditation Standards Diverse Populations Tools & Technologies Microsoft Office Suite Electronic Health Records #J-18808-Ljbffr Jobtailor