Case Manager

Overview

• Provide comprehensive case management services to address members' medical, social, and psychological needs, ensuring optimal care coordination and support.
• Collaborate with interdisciplinary teams to create and monitor individualized care plans tailored to members' unique circumstances.
• Ensure compliance with managed care regulations, policies, and guidelines to enhance service quality and member satisfaction.
• Utilize case management principles to improve members' health outcomes and overall well-being effectively.
• Work primarily in a remote capacity with occasional in-office training and monthly meetings in a hybrid setup.
• Provide specialized support to bilingual Mandarin/Cantonese-speaking members, addressing their specific needs and preferences.
• Licensed professionals may qualify for a sign-on bonus or student loan assistance, enhancing career growth opportunities.

Key Responsibilities & Duties

• Develop and oversee care plans tailored to individual member needs, collaborating with interdisciplinary teams for holistic support.
• Conduct thorough assessments to identify members' medical, social, and psychological requirements for effective case management.
• Ensure compliance with managed care regulations and guidelines during all case management activities.
• Utilize InterQual and Medicare coverage guidelines to ensure accurate and effective case management processes.
• Maintain detailed documentation of member interactions and care plans using relevant software tools.
• Participate in monthly in-office meetings and training sessions to stay updated on best practices and policies.
• Provide bilingual support to Mandarin/Cantonese-speaking members, ensuring culturally sensitive and effective service delivery.

Job Requirements

• Master of Social Work degree required; LMSW or LCSW certification preferred for advanced practice.
• Minimum of two years of experience in MLTC or Medicare managed care settings.
• Proficiency in utilization management processes and case management principles for effective service delivery.
• Knowledge of federal and state managed care regulations, InterQual, and Medicare coverage guidelines.
• Strong written and verbal communication skills to interact effectively with members and teams.
• Proficiency in Windows, Word, and Excel for accurate documentation and reporting.
• Bilingual proficiency in Mandarin or Cantonese preferred to support diverse member needs.