Case Manager (Registered Nurse [RN] or Licensed Master Social Worker [LMSW])

As a Case Manager, you will support Idaho Medicaid participants through complex medical case management, patient navigation, and care coordination. The role focuses on developing individualized care plans that promote wellness, improve health outcomes, and reduce reliance on emergency services and inpatient care. The Case Manager engages with members primarily by phone and email, while collaborating closely with healthcare providers, community resources, and interdisciplinary teams. This position supports diverse patient populations and plays a key role in helping members understand and access available benefits, services, and medically necessary care. Core business hours are Monday through Friday, 9:00 a.m. to 5:30 p.m. Mountain Time, with flexibility required to meet member needs, including occasional non-business hours. What you’ll do Performs assessments and evaluations of potential care management patients in accordance with client contractual obligations and/or state requirements. Collaborates with healthcare providers and ancillary service providers to validate appropriate treatment plans and identify patient education opportunities. Assessment and education activities may include face-to-face interactions for specific contracts. Effectively guides members to appropriate benefit information. Provides ongoing education to patients and communicates with healthcare providers to ensure the appropriateness of care. Recommends and implements adjustments to care plans as needed. Evaluates treatment adherence and reassesses patient commitment to necessary behavioral or lifestyle changes. Documents activities in accordance with contractual requirements, including individual member status, medical necessity reviews, and negotiations. Escalates issues through appropriate channels while adhering to established hierarchical protocols between clinical and non-clinical staff. Required Skills and Experience Bachelor’s degree in healthcare or a related field and/or equivalent training or experience. Current Registered Nurse (RN) or Master Social Worker (LMSW). Case Management Certification (CMC) required, or ability to obtain certification within two years of hire. Minimum of one (1) year of experience in human services and/or three (3) years of clinical practice experience. Preferred Skills and Experience Prior case management (CM), utilization management (UM), or care coordination experience strongly preferred. Experience in human services is strongly preferred. Positions working on specific contracts may require U.S. Citizenship. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms. Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class. Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case-by-base basis. If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to View email address on click.appcast.io #J-18808-Ljbffr Telligen