Case Manager

Overview

• Provide comprehensive case management services to members, addressing medical, social, psychological, physical, and spiritual needs.
• Collaborate with primary care providers, caregivers, and interdisciplinary teams to develop, implement, and monitor individualized care plans.
• Work in a hybrid environment, transitioning to remote work after training in Lower Manhattan.
• Participate in monthly in-office meetings to ensure alignment and effective communication.
• Opportunity for bilingual Mandarin/Cantonese candidates to address diverse member needs.
• Eligible licensed candidates (LMSW/LCSW) may qualify for a sign-on bonus or student loan assistance.
• Contribute to a mission-driven organization focused on member-centered care management.

Key Responsibilities & Duties

• Develop and monitor care plans in collaboration with primary care providers and interdisciplinary teams.
• Conduct assessments to identify member needs and coordinate appropriate services and resources.
• Ensure compliance with federal and state managed care regulations and guidelines.
• Utilize InterQual criteria and local Medicare coverage guidelines in case management processes.
• Maintain accurate documentation using Windows-based systems, including Word and Excel.
• Provide bilingual support in Mandarin/Cantonese to enhance member communication and care.
• Participate in monthly in-office meetings and ongoing training sessions.
• Support utilization management processes to optimize member care outcomes.

Job Requirements

• Master of Social Work degree required; LMSW or LCSW preferred.
• Minimum of three years of experience in MLTC or Medicare managed care.
• Proficiency in utilization management processes and case management.
• Knowledge of federal and state managed care regulations and InterQual criteria.
• Strong written and verbal communication skills; bilingual Mandarin/Cantonese preferred.
• Proficiency in Windows-based systems, including Word and Excel.
• Ability to work in a hybrid environment with monthly in-office meetings.
• Licensed candidates eligible for sign-on bonus or student loan assistance.