Case Manager
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Job Description
Remote Registered Nurse case manager coordinating disease management, assessments, and care plans for Wholecare Medicaid members. Supporting self-management through telephonic outreach, education, and provider coordination.
Responsibilities:
- Manage members with complex health needs across the continuum of case management services
- Conduct telephonic clinical assessments addressing members’ health and wellness needs
- Support members with chronic and complex conditions through education, coaching, resources, and interventions
- Develop case-specific or condition-specific plans of care using the clinical information system
- Establish short- and long-term health goals
- Maintain regular telephonic contact with members to review progress and reassess needs
- Modify care plans when appropriate
- Communicate with treating providers in complex clinical situations
- Provide education, consultation, and training to other clinical teams
- Identify online, telephonic, and community-based resources and assist members in accessing services
- Educate members about health conditions, self-management, preventive care, lifestyle improvements, and healthcare resources
- Incorporate preventive health services and lifestyle improvement opportunities into member interactions
- Accurately document activities according to business processes, regulatory requirements, and accreditation standards
- Assist with appeals/denials, provider inquiries, claims processing, and benefit information interpretation
- Coordinate specialized services such as transplant facilities and other member support programs
- Perform other duties as assigned
Requirements:
- Must hold a current, active Registered Nurse (RN) license in Pennsylvania
- Must reside in Pennsylvania to work remotely
- US Citizenship required
- 5+ years of relevant healthcare/case management experience
- Disease Management experience required
- Strong clinical assessment experience, particularly for care coordination and member education
- Prior Case Management experience
- Experience working in Managed Care environments
- Experience working with Medicaid populations strongly preferred
- Telephonic Case Management / telephonic outreach experience preferred
- Experience developing and managing individualized care plans
- Experience identifying and coordinating community resources
- Knowledge of preventive health services and chronic disease management
- Experience with an 1-800/member service line preferred
- Strong clinical assessment and care coordination skills
- Excellent verbal and written communication skills
- Strong member education and motivational interviewing abilities
- Ability to work independently and effectively manage time and caseloads
- Strong organizational and documentation skills
- Compassionate and professional approach when working with members
- Strong understanding of chronic disease management and health promotion
- Excellent work ethic and ability to operate effectively in a remote environment
- Must complete the Care Manager Assessment
- Certified Case Manager (CCM) certification preferred
Benefits:
- Contract duration: 6 months
- Remote work arrangement for candidates residing in Pennsylvania
- ASAP start date
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