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 and monitor individualized care plans.
• Ensure compliance with federal and state managed care regulations and guidelines.
• Utilize knowledge of utilization management processes and case management principles to optimize member outcomes.
• Work remotely with occasional in-office training and monthly meetings in a hybrid setup.
• Assist bilingual Mandarin/Cantonese members effectively, addressing their unique needs.
• Opportunity for licensed professionals to qualify for a sign-on bonus or student loan assistance.

Key Responsibilities & Duties

• Develop, implement, and monitor care plans tailored to member needs in collaboration with interdisciplinary teams.
• Conduct assessments to identify medical, social, and psychological needs of members.
• Ensure adherence to managed care regulations and guidelines during case management processes.
• Utilize InterQual and local Medicare coverage guidelines for effective case management.
• Maintain accurate documentation of member interactions and care plans using Windows, Word, and Excel.
• Participate in monthly in-office meetings and training sessions as required.
• Provide bilingual support to Mandarin/Cantonese-speaking members to enhance service delivery.

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 principles.
• Knowledge of federal and state managed care regulations, InterQual, and Medicare coverage guidelines.
• Strong written and verbal communication skills for effective member interactions.
• Proficiency in Windows, Word, and Excel for documentation and reporting.
• Bilingual proficiency in Mandarin or Cantonese preferred.