Case Manager Behavioral Health (Remote) (Healthcare)

TL;DR

Case Manager Behavioral Health (Remote) (Healthcare): Providing comprehensive case management for members with behavioral health needs in Pennsylvania, with an accent on clinical assessment, individualized care planning, and coordinated access to services. Focus on managing moderate-complexity cases, preventing improper utilization, improving outcomes, and identifying cost-saving opportunities.

Location: Remote, Pennsylvania, United States. The role is designated as working at home in Pennsylvania, with 0–25% travel and an office-based position classification.

Company

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

What you will do

• Manage a caseload of members with moderate-complexity behavioral health needs.
• Assess member health status, needs, resources, and available benefits.
• Develop, implement, coordinate, and adjust individualized care plans with members and healthcare providers.
• Monitor progress, evaluate intervention effectiveness, and provide coaching or intensive case management.
• Communicate with physicians, treating providers, and care teams in complex clinical situations.
• Identify opportunities for cost savings, quality improvement, workflow efficiency, and prevention of improper benefit utilization.

Requirements

• Required licensure: Current state RN or enhanced Nurse Licensure Compact multi-state license, or LSW, LCSW, LMSW, LPC, LMHC, or LMFT license.
• Master’s degree for licensed behavioral health professionals, or an associate’s degree with an RN license.
• At least 3 years of experience in clinical care, case or utilization management, disease management, provider operations, or health insurance.
• Strong assessment and care-planning skills, with the ability to work independently and collaboratively.
• Proficiency with Microsoft applications, case management software, and electronic health records.
• Understanding of healthcare systems and case management principles.

Nice to have

• Bachelor’s or master’s degree in nursing for RN candidates.
• Certified Case Manager (CCM) certification.
• Experience supporting diverse populations and applying culturally competent care.

Culture & Benefits

• Remote, work-from-home arrangement in Pennsylvania.
• Collaboration with physicians, providers, and multidisciplinary healthcare teams.
• Work focused on quality, cost-effective care and improved member outcomes.
• Travel requirement of 0–25%.
• Work performed in compliance with healthcare regulations, accreditation standards, HIPAA, and company policies.