Case Manager

Jobtailor; California (MO); On-site; USD 70,000 - 110,000; Full time

Job summary

Jobtailor is seeking a qualified nurse case manager to provide professional health nursing care in clinical settings and coordinate DoW beneficiaries' care plans.

The role emphasizes collaboration with multi-disciplinary teams, adherence to VA/DoW guidelines, and ensuring cost-effective, high-quality outcomes with strong communication and documentation skills.

Qualifications

• RN or MSW with independent license per CSWE
• 2+ years nursing or case management experience; CM cert or will obtain within 1 year
• Strong teamwork, facilitation, and communication skills
• Familiarity with VA/DoW guidelines and standardized care processes
• Knowledge of TRICARE and Medicare benefits and services

Responsibilities

• Provide nursing care per professional standards in clinical settings for DoW beneficiaries.
• Collect and organize data to develop timely treatment plans.
• Assess clients using established protocols to deliver appropriate care.
• Set care priorities and monitor progress toward goals.
• Oversee discharge planning and referrals to resources.

Skills

Team coordination

Facilitation

Communication

Case management

Policy knowledge (TRICARE/Medicare)

Evidence-based practice

Education

Registered nurse degree (RN)

Master’s in Social Work with independent LCSW

Job description

Responsibilities

• Provide a full range of professional health nursing principles, practices, and procedures in clinical settings or within the local unit, to analyze the full scope of problems associated with providing appropriate, cost-effective care to DoW beneficiaries.
• Collect, organize, record, and communicate data relevant to primary health assessments including detailed medical history to develop time sensitive treatment plans which delineate the expected process of care delivery for selected case managed clients or populations.
• Assess clients, using established protocols, to provide appropriate and cost-effective care.
• Establish priorities for client care, monitor and evaluate progress toward the stated goals to provide coordinated, efficient, effective health care.
• Oversee discharge‑planning activities to ensure ideal timing and sequencing of client care.
• Provide professional assistance with health care resources to identify clients’ needs for referrals to appropriate health care providers or facilities.
• Negotiate, write, finalize, and administer product/service agreements to ensure mutual compliance in meeting care goals.
• May also serve as the central point and POTFF program lead for tracking and referring service members into cross‑functional teams, and multi‑domain services for a common problem set such as sleep, physical or mental injury.
• They will also be responsible for development, execution of multi‑domain initiatives and will collect, analyze, and report their data to higher level authority as requested.

Requirements

• Minimum 2‑year degree as a registered nurse from a fully accredited school OR a Master’s degree in social work from a fully accredited graduate school by the Council on Social Work Education (CSWE) and licensed at an independent level in social work (LCSW or equivalent).
• Minimum of two (2) years’ nursing experience or case management and be certified as a case manager by a recognized certifying organization, i.e., Commission for Case Management Certification, American Case Manager Association, or American Nurse Credentialing Center or shall obtain the certification within one (1) year of hiring.
• Skill in team coordination, facilitation, and communication to facilitate the exchange of information/ education, enhance goal achievement; augment abilities of client support network, and effect change in system or policy at any level.
• Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to ensure an evidence‑based standardized process of care to military beneficiaries.
• Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
• Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
• Knowledge of pharmaceuticals, their desired effects, side effects, and complications of their use to gauge their effect on clients and their recovery.
• Knowledge of community resources, client entitlement/benefit eligibility, and ability to access these resources to assist clients/families in optimizing their level of function and self‑care.
• Knowledge of current third‑party regulations and policies, with special emphasis on TRICARE and Medicare benefits and services, to identify alternative financing sources to which DoW beneficiaries may be entitled.
• Professional oral and written communication skills with peers, outside agencies, vendors, providers, and Military Health System (MHS) stakeholders to exchange information, provide briefings, presentations, research, and metrics to demonstrate or advance effective, efficient case management practice, outcomes, and organizational/MHS value.