Medical Case Manager - Delaware

Location: Hybrid work-from-home and community-based position in Delaware, United States, with frequent travel within the assigned territory and occasional physical work-site attendance.

Company

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

What you will do

• Manage a caseload of members with moderately complex health needs.
• Assess member health status, needs, resources, and barriers to care.
• Develop, implement, coordinate, and adjust individualized care plans with members, physicians, providers, and healthcare teams.
• Coordinate referrals to specialists and community resources while monitoring progress toward care goals.
• Document activities and ensure compliance with company policies, regulatory requirements, accreditation standards, and business processes.
• Identify opportunities for cost savings, quality improvement, improper-utilization prevention, and workflow efficiency.

Requirements

• Three years of combined clinical, case or utilization management, disease condition management, provider operations, or health insurance experience with RN licensure or a master's degree; alternatively, 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 bachelor's degree in social work.
• Current state RN licensure, enhanced Nurse Licensure Compact multi-state licensure, or one of the listed social work or counseling licenses is required.
• Strong assessment and care-planning skills, knowledge of healthcare systems and case management principles, and the ability to work independently and collaboratively.
• Proficiency with Microsoft Office, case management software, and electronic health records.
• Travel is required within the assigned territory, with travel expectations listed as 0%–25%.

Nice to have

• Medicaid managed care or Medicare experience.
• Experience supporting diverse populations and applying cultural competency.
• Bilingual English/Spanish language skills.
• Certified Case Manager certification.

Culture & Benefits

• Hybrid work combining home-based and community-based activities.
• Direct member support in homes, hospitals, primary care offices, and other care settings.
• Work focused on advocacy, quality outcomes, appropriate service access, and healthcare cost management.
• Position may be office-based or remote, with occasional physical work-site attendance.