Medical Case Manager (Healthcare)

Location: Remote or office-based in Pennsylvania; physical work site required occasionally

Company

hirify.global provides health insurance and healthcare services focused on quality, cost-effective member outcomes.

What you will do

• Manage a caseload of members with moderate-complexity health needs.
• Assess member health status, needs, resources, and available benefits.
• Develop and implement individualized care plans with members, physicians, and healthcare providers.
• Coordinate referrals, services, and community resources while monitoring progress toward goals.
• Advocate for members and evaluate the effectiveness of interventions.
• Identify opportunities for cost savings, quality improvement, and workflow efficiency while maintaining accurate documentation.

Requirements

• Three years of combined clinical, case or utilization management, disease management, provider operations, or health insurance experience with RN licensure or a master's degree; or five years of experience with a bachelor's degree in social work.
• Bachelor's degree in nursing, RN licensure, master's degree in social work, counseling, or a related field, or a bachelor's degree in social work.
• Current state RN licensure or current multistate licensure through the enhanced Nurse Licensure Compact, or one of the specified social work or counseling licenses.
• Strong assessment and care planning skills, with the ability to work independently and collaboratively.
• Proficiency with Microsoft Office, case management software, and electronic health records.
• Work eligibility is tied to Pennsylvania-based remote or office work, with occasional physical-site attendance.

Nice to have

• Telephonic case management experience.
• Medicaid managed care or Medicare experience.
• Experience supporting diverse populations and applying cultural competency.
• Certified Case Manager (CCM) credential.
• Bilingual English and Spanish language skills.

Culture & Benefits

• Remote or office-based work arrangement.
• Travel requirement of 0%–25%.
• Work is conducted under healthcare privacy, regulatory, accreditation, and information-security standards, including HIPAA.