Manager Case Management Long-term Care (Medical)

TL;DR

Manager Case Management Long-term Care (Medical): Supervising a team of Case Manager Supervisors to optimize member outcomes and resource use with an accent on regulatory compliance and quality of care. Focus on overseeing utilization management, strategic planning, and meeting State of Delaware reporting requirements for LTSS services.

Location: Working at Home / Office-based in Delaware

Company

hirify.global is a leading healthcare organization focused on improving member outcomes and optimizing benefits through integrated care management.

What you will do

• Supervise a team of Case Manager Supervisors, overseeing hiring, coaching, and performance management.
• Manage day-to-day operations of the case management department, including policy development and implementation.
• Ensure care is medically appropriate and cost-effective while promoting high-quality member outcomes.
• Maintain compliance with regulatory agencies including NCQA, URAC, CMS, DOH, and DOL.
• Coordinate with internal departments such as Medical Directors and Behavioral Health teams, as well as external stakeholders.
• Lead special projects and ensure all State of Delaware LTSS reporting requirements are met.

Requirements

• Bachelor's degree in Health Administration, Public Health, or a related field.
• Must possess a current, valid, unrestricted license: LCSW, LSW, LPC, or RN (including eNLC).
• 5 years of clinical setting experience.
• 3 years of experience in case management or managed care.
• 3 years of experience in a management or leadership role.
• Must be based in Delaware.

Nice to have

• Master's degree in a related human services field.
• CCM (Certified Case Manager) Certification.
• Experience with Medicare or Medicaid.
• Experience in geriatric special needs or behavioral health.

Culture & Benefits

• Collaborative interdisciplinary work environment.
• Opportunities for professional development and career growth.
• Focus on high-quality performance standards and member-centric care.
• Hybrid work arrangement (Working at Home options within Delaware).