Medical Case Manager (Medtech)

TL;DR

Medical Case Manager (Medtech): Facilitating comprehensive care coordination for members with complex medical and psychosocial needs with an accent on clinical assessment, care plan development, and interdisciplinary collaboration. Focus on improving health outcomes, ensuring adherence to treatment regimens, and navigating community resources for Medicaid and Medicare populations.

Location: Must be based in Pennsylvania

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 primary care physicians, specialists, and ancillary providers to coordinate care.
• Monitor member progress toward goals and adjust care plans based on clinical judgment.
• Educate members on disease management, pharmacy regimens, and health plan benefits.
• Participate in interdisciplinary team meetings and rounds to facilitate service coordination.
• Maintain accurate documentation in compliance with regulatory guidelines and HIPAA standards.

Requirements

• Must be based in Pennsylvania
• Bachelor’s degree in Nursing (with RN license) OR Master’s degree in Social Work, Counseling, or related field.
• Minimum 3 years of experience in Acute or Managed Care with Medicaid or Medicare populations.
• Active licensure as an RN, LSW, LPC, LBSW, LCSW, LMSW, or LGSW.
• Strong clinical judgment and ability to work independently in a team environment.
• Proficiency in medical terminology and diagnostic categories.

Nice to have

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

Culture & Benefits

• Comprehensive health and wellness benefits package.
• Commitment to ethical standards and data privacy compliance.
• Opportunities for professional development and continuing education.
• Collaborative team environment focused on member advocacy.