Medical Case Manager (Healthcare)

TL;DR

Medical Case Manager (Healthcare): Coordinating high-quality, cost-effective healthcare for members with complex medical and psychosocial needs with an accent on holistic assessment and care planning. Focus on advocating for appropriate care plans, collaborating with providers, and monitoring member progress across the continuum of care.

Location: Hybrid (Work from home and community-based). Must be based in Delaware (New Castle County)

Company

hirify.global is a leading healthcare organization focused on providing high-quality, cost-effective health services.

What you will do

• Perform holistic assessments and develop individualized care plans for members with complex medical and psychosocial needs.
• Coordinate care with Primary Care Physicians, specialists, and home health providers to ensure access to healthcare services.
• Educate members on illness impact and pharmacy regimens to improve health outcomes and care plan adherence.
• Facilitate interdisciplinary and interagency meetings to coordinate services and resources.
• Monitor member progress toward goals and readjust care plans based on clinical judgment.
• Collaborate with other payers and community organizations to identify and provision additional resources.

Requirements

• Bachelor’s degree in Nursing (RN), Social Work, Counseling, Education, or a related field.
• 3-5 years of experience in Acute or Managed Care, specifically with Medicaid or Medicare populations.
• Current valid licensure: LSW, LPC, LBSW, LCSW, LMSW, LGSW, or RN licensure (State or eNLC).
• Must be located in Delaware (New Castle County) to perform frequent travel within the assigned territory.

Nice to have

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

Culture & Benefits

• Hybrid work model combining working from home with community-based field work.
• Support for annual continuing education to enhance clinical skills and maintain professional licensure.
• Collaborative team environment involving interdepartmental cooperation with Physician Advisors and Management.
• Commitment to ethical and legal standards in healthcare delivery.