Case Manager

Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Case Manager.

They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.

Location : While the position is Remote, work from home, you must reside in North Carolina or one of the following states : Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

Contract Duration : 3+ Months

Required Skills & Experience

• Computer experience needed, documentation skills and communication
• RN degree for 5-7 years
• RN, RD or LCSW with 3 years of clinical and / or case management experience required. For some roles a Master's in Social Work with 5 years of related experience may be considered.
• For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
• For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment.

Desired Skills & Experience

Case Management

What You Will Be Doing

• Serve as a team member on a multidisciplinary team, coordinating care, resources and / or services for members to achieve optimal clinical and resource outcomes.
• Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services / providers on plans for treatment, appropriate intervention and / or discharge planning.
• Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs;

identify barriers to meeting goals or plan of care

• Utilize community resources and funding sources as needed in the development of the plan of care.
• Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services / education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan / goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
• Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• May outreach directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop relevant policies / procedures, education or training for use both internally and externally.

To be eligible to contract at this client you must be able to pass a drug test and criminal background check