Medical Case Manager (Medical)

TL;DR

Medical Case Manager (Medical): Providing comprehensive case management for members with complex medical and psychosocial needs in PA, DE, and WV with an accent on holistic assessment and coordination of cost-effective care. Focus on developing individualized care plans, collaborating with healthcare providers, and advocating for optimal member outcomes.

Location: Remote (Must be based in Pennsylvania, Delaware, or West Virginia)

Company

hirify.global is a leading healthcare organization providing health insurance and comprehensive medical services.

What you will do

• Perform holistic assessments and develop individualized care plans for members with complex medical needs.
• Coordinate care by collaborating with Primary Care Physicians, medical specialists, and home health providers.
• Educate members on disease impact, medication adherence, and health outcomes to improve overall care.
• Advocate for appropriate care plans using sound clinical judgment and established regulatory guidelines.
• Facilitate interdisciplinary meetings and collaborate with internal Physician Advisors to resolve member needs.
• Monitor member progress toward goals and re-adjust care plans as indicated.

Requirements

• Bachelor’s degree in Nursing (RN certification) or Master’s degree in Social Work, Counseling, or Education.
• 3-5 years of experience in Acute or Managed Care, specifically with Medicaid or Medicare populations.
• Current state licensure (RN, LSW, LPC, LCSW, LMSW, or LGSW) is required.
• Must be based in PA, DE, or WV.

Nice to have

• Case Management Certification.
• Bilingual proficiency in English and Spanish.
• Experience working with high-risk pregnant women, chronic adult conditions, or pediatrics.

Culture & Benefits

• Full remote work-from-home arrangement.
• Opportunities for annual internal and external continuing education to maintain professional licensure.
• Collaborative team environment with a focus on interdisciplinary coordination.
• Commitment to ethical and legal standards in healthcare business conduct.