Case Manager Long-term Care - RN (Medical)

TL;DR

Case Manager Long-term Care (Medical): Coordinating comprehensive care needs for members across various service delivery systems and community supports with an accent on long-term services and supports (LTSS). Focus on conducting face-to-face needs assessments in nursing facilities and homes, designing individualized care plans, and facilitating safe transitions between care settings.

Location: Must be based in Delaware (Kent and New Castle County); this is a community-based role requiring frequent travel to members' homes and nursing facilities.

Company

hirify.global is a leading healthcare provider and insurance organization dedicated to coordinating member care and improving health outcomes.

What you will do

• Coordinate care needs for members across various service delivery systems and community supports.
• Conduct regular in-home and nursing facility visits to perform face-to-face needs assessments.
• Develop and implement individualized care plans for members with chronic and complex healthcare or social needs.
• Authorize LTSS services and coordinate HCBS, Medicaid, and DSNP benefits.
• Facilitate care transitions between settings, such as from hospital to home or nursing facility to community.
• Collaborate with interdisciplinary teams, including behavioral health providers and discharge planners.

Requirements

• Current State RN or LPN licensure (or multi-state licensure through eNLC).
• Bachelor's degree in Social Work or health services with 3 years of experience, OR a Master's degree with 1 year of experience in long-term care, home health, or public health.
• Reliable transportation for daily travel within the assigned Delaware territory.
• Proficiency in PC-based word processing and database documentation (Word, Excel, Outlook).
• Dedicated home workspace used exclusively for business purposes.

Nice to have

• Certified Case Manager (CCM) certification.
• Licensure as a LBSW, LMSW, or LCSW.
• Experience working with HIV/AIDS, behavioral health, or developmental disabilities populations.
• Experience with Medicare and Medicaid managed care.

Culture & Benefits

• Hybrid work model combining a home-based office with active community field work.
• Commitment to cultural competency in addressing targeted populations.
• Professional environment adhering to strict ethical and HIPAA compliance standards.
• Focus on providing care in the safest and least restrictive environment possible.