Case Manager

Overview

• Provide compassionate case management services addressing diverse member needs, including medical, social, psychological, physical, and spiritual aspects.
• Collaborate with interdisciplinary teams to create and implement personalized care plans ensuring optimal member outcomes.
• Work in a hybrid environment, transitioning to remote work after initial training sessions.
• Participate in monthly in-office meetings to maintain effective communication and alignment.
• Opportunity for bilingual Mandarin/Cantonese candidates to address diverse member needs effectively.
• Licensed candidates (LMSW/LCSW) may qualify for a sign-on bonus or student loan assistance.
• Join a mission-driven organization committed to member-centered care management and professional growth.

Key Responsibilities & Duties

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

Job Requirements

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