Medical Case Manager (Medtech)

TL;DR

Medical Case Manager (Medtech): Providing comprehensive case management services to members with moderate complexity health needs with an accent on care plan development, coordination, and cost-effective health outcomes. Focus on assessing member needs, collaborating with healthcare providers, and ensuring compliance with regulatory and accreditation standards.

Location: Must be based in Delaware. This is a hybrid position requiring frequent travel within the assigned territory for in-home and community-based visits.

Company

hirify.global is a large healthcare organization providing health insurance and managed care services.

What you will do

• Manage a caseload of members with moderate complexity health needs.
• Assess member health status and develop individualized care plans.
• Coordinate referrals to specialists and community resources.
• Monitor member progress and adjust care plans to ensure optimal outcomes.
• Advocate for members to ensure access to quality, cost-effective services.
• Document all activities in compliance with company policies and regulatory requirements.

Requirements

• Must be based in Delaware or able to work within the assigned territory.
• Bachelor’s degree in Nursing or RN licensure, or Master’s degree in Social Work/Counseling, or Bachelor’s degree in Social Work.
• 3-5 years of experience in clinical, case management, or health insurance operations.
• Active licensure as an RN, LSW, LBSW, LCSW, LMSW, LGSW, or LPC.
• Proficiency in Microsoft Office and electronic health records.
• Ability to travel frequently within the assigned territory.

Nice to have

• Experience with Medicaid managed care or Medicare.
• Experience working with diverse populations and cultural competency.
• Certified Case Manager (CCM) certification.
• Bilingual English/Spanish language skills.

Culture & Benefits

• Full-time employment with a focus on professional development.
• Opportunity to work directly with members in the community.
• Collaborative team environment with physicians and healthcare providers.
• Adherence to high ethical and legal standards in healthcare.