Medical Case Manager (Medicaid/Medicare)

TL;DR

Medical Case Manager (Medicaid/Medicare): Facilitating comprehensive care coordination for members with complex medical and psychosocial needs with an accent on holistic assessment, care planning, and interdisciplinary collaboration. Focus on advocating for appropriate care plans, monitoring member progress, and ensuring adherence to regulatory guidelines within the Delaware territory.

Location: Must be based in Delaware with frequent travel within the assigned territory.

Company

hirify.global is a national health and wellness organization providing comprehensive healthcare services and insurance solutions.

What you will do

• Conduct holistic assessments and develop individualized care plans for members with complex needs.
• Collaborate with physicians, specialists, and community agencies to coordinate healthcare services.
• Monitor member progress toward goals and adjust care plans based on clinical judgment.
• Educate members on disease management, pharmacy regimens, and care plan adherence.
• Participate in interdisciplinary team meetings and quality initiative workgroups.
• Maintain accurate documentation of all member interventions in compliance with regulatory standards.

Requirements

• Bachelor’s degree in Nursing (with RN license) OR Master’s degree in Social Work/Counseling/Education.
• Minimum 3 years of experience in Acute Care, Managed Care, Medicaid, or Medicare populations.
• Current state licensure (RN, LSW, LPC, LCSW, LMSW, or LGSW) required.
• Must be based in Delaware and able to travel frequently within the state.
• Strong communication skills for telephonic interviewing and interdepartmental collaboration.
• Proficiency in medical terminology and disease state management.

Nice to have

• Experience working with high-risk pregnant women, chronic adult populations, or pediatrics.
• Bilingual English/Spanish language skills.
• Case Management Certification.

Culture & Benefits

• Full-time employment with a focus on professional development and continuing education.
• Collaborative team environment with interdisciplinary support.
• Commitment to ethical standards and HIPAA compliance.
• Opportunities to participate in organizational quality initiatives.