Case Manager

Overview

• Join a dynamic healthcare team as a Case Manager, focusing on Medicare case management and complex care coordination for members aged 65+.
• Provide remote case management services across approved states, ensuring comprehensive care plans tailored to individual member needs.
• Collaborate with internal and external partners to facilitate effective treatment plans and discharge planning for members.
• Utilize clinical expertise to perform assessments and monitor member progress, modifying care plans as needed.
• Leverage community resources and funding sources to address barriers and optimize member outcomes.
• Document all aspects of case management, from initial assessment to evaluating outcomes, ensuring compliance and accuracy.
• Opportunity to work with diverse cases involving chronic conditions such as CKD, diabetes, and hypertension.
• Contract role offering flexibility and remote work options in approved states.

Key Responsibilities & Duties

• Conduct comprehensive assessments to determine member needs and develop tailored care plans addressing health and support requirements.
• Collaborate with members, families, and healthcare providers to ensure effective intervention and discharge planning.
• Monitor member progress, modify care plans, and provide education to promote proactive health management.
• Evaluate care provided across various settings, ensuring continuity and quality of services.
• Outreach to high-risk members to assess alternative treatment plans and benefits options.
• Document all case management activities, maintaining compliance with organizational policies and standards.
• Develop and implement policies, procedures, and training programs to enhance case management practices.
• Utilize technology systems to manage cases effectively and ensure accurate documentation.

Job Requirements

• Bachelor of Science in Nursing (BSN) required; valid clinical license in NC or compact multi-state licensure mandatory.
• Minimum 3 years of clinical and/or case management experience; 5 years preferred for advanced roles.
• Experience with chronic conditions such as CKD, diabetes, hypertension, and Medicare case management essential.
• Proficiency in utilizing healthcare systems and technology for documentation and case management.
• Specialty certifications such as CCM or CDCES preferred; must obtain within 2 years if required.
• Strong knowledge of community resources and funding sources to support member care plans.
• Ability to work remotely across approved states, with preference for NC-based candidates.
• Advanced skills in managing complex cases involving conditions like Parkinson's Disease, ALS, and Sickle Cell Anemia.