Medical Case Manager - Remote

Overview

The Medical Case Manager ensures that members with complex medical and psychosocial needs have access to high-quality, cost-effective healthcare. This role involves assessment, planning, coordination, and monitoring of healthcare services to facilitate member access.

In Short

• Facilitates holistic assessment and planning for healthcare access.
• Advocates for appropriate care plans using clinical judgment.
• Communicates effectively with members and healthcare providers.
• Educates members about illness and care plan adherence.
• Collaborates with various healthcare professionals for member care.
• Develops individualized care plans based on member needs.
• Maintains knowledge of community resources for member assistance.
• Participates in team meetings for effective care coordination.
• Attends continuing education to enhance clinical skills.
• Adheres to ethical and legal standards in case management.

Requirements

• Bachelor’s degree in nursing or related field, or RN certification.
• 3-5 years of experience in Acute or Managed Care.
• Experience with Medicaid or Medicare populations.
• Preferred experience with high-risk pregnant women or chronic conditions.
• Bilingual English/Spanish is a plus.
• Case Management Certification is required.
• Licensure in West Virginia is required.
• Strong communication and collaboration skills.
• Ability to work independently and as part of a team.
• Knowledge of medical terminology and diagnostic categories.

Benefits

• Competitive salary range of $57,700 - $107,800.
• Comprehensive health benefits.
• Opportunities for professional development.
• Supportive team environment.
• Flexible working conditions.