Case Manager

Motion Recruitment Partners LLC; Durham (NC); Remote; USD 60,000 - 80,000; Full time

Job summary

Motion Recruitment Partners LLC is seeking a Case Manager to join an award-winning health insurance company. This remote position requires a valid clinical license and at least 3 years of clinical experience. The role focuses on coordinating care for members and improving healthcare outcomes through tailored care plans and ongoing assessments.

Qualifications

• Minimum of 3 years of clinical experience required.
• Must maintain a valid and applicable clinical license.
• Experience in Behavioral Health preferred.

Responsibilities

• Coordinate care and resources for members to achieve optimal clinical outcomes.
• Develop member-centric care plans based on comprehensive assessments.
• Monitor members through follow-ups and ongoing assessments.

Skills

Case Management

Clinical experience

Time management

Education

Valid clinical license (NC or compact multi-state)

Job description

Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Case Manager. They serve over 4 million customers and have more than 5,000 employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes, and reduce costs.

Location: While the position is remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

Contract Duration: 5+ Months

Required Skills & Experience

• For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
• Case Management (CM) experience.
• Wide-ranging nursing experience (not limited to a single nursing silo).
• Non-compact licensure.

Desired Skills & Experience

• Telephonic experience.
• Proven experience with time management.
• Comfortable working in different systems.

What You Will Be Doing

Daily Responsibilities:

• Serve as a team member on a multidisciplinary team, coordinating care, resources, and/or services for members to achieve optimal clinical and resource outcomes.
• Utilize clinical skills to perform comprehensive assessments and develop member-centric care plans tailored to individual needs, health status, educational background, and support requirements.
• Identify barriers to meeting goals and develop strategies to overcome them, utilizing community resources and funding sources as needed.
• Monitor and manage members through scheduled follow-ups, discussions, education, referrals, and ongoing assessment and plan modifications.
• Evaluate and facilitate care across the continuum (e.g., physician offices, hospitals, rehabilitation units, skilled nursing facilities, home care).
• Educate members and promote proactive interventions to improve outcomes and manage costs.
• Document all aspects of the care plan thoroughly, from assessment to evaluation.
• May outreach directly to high-risk, high-cost, or high-utilization members.
• Review treatment plans and assess benefits and eligibility for benefits exceptions or flex options.
• Evaluate medical necessity and service appropriateness as defined by department policies.
• Develop relevant policies, procedures, education, or training as needed.

Additional Requirements: To be eligible to contract with this client, you must pass a drug test and criminal background check.