Case Manager

Pyramid, Inc; Durham (NC); Remote; USD 48,000 - 52,000; Full time

Job summary

Pyramid, Inc. is seeking an experienced Case Manager for a 06+ months contract located in the US (Remote). The role requires an active RN license (NC or multi-state) and at least 3 years in clinical/case management, with EMR experience and managed care exposure.

You will coordinate care, conduct assessments, and develop tailored plans while collaborating with a multidisciplinary team. You must be able to work remotely in a dynamic environment, document progress, and promote optimal outcomes.

Qualifications

• RN with active license and 3+ years in clinical and/or case management.
• Experience using Electronic Medical Records (EMR).
• Managed care experience; MCO exposure a plus.
• Hospital bedside experience required (3 years).
• Strong critical thinking and independent work ethic.

Responsibilities

• Coordinate care on a multidisciplinary team to optimize outcomes.
• Perform comprehensive assessments for treatment and discharge planning.
• Develop member-centric care plans addressing health and support needs.
• Utilize community resources and funding to support plans.
• Monitor progress, adjust plans, and document outcomes.
• Facilitate care across settings (clinic, hospital, home care).
• Educate members to promote positive outcomes and cost awareness.
• Document all plan phases from assessment to evaluation.

Skills

Case Management

Critical thinking

Independent worker

Tech-savvy

Education

RN license

3 years clinical/case mgmt

Tools

EMR systems

Job description

Immediate need for a talented Case Manager. This is a 06+ months contract opportunity with long-term potential and is located in US (Remote).

Pay Range: $35 - $38/hr. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key 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 applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning.
• Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care
• Utilize community resources and funding sources as needed in the development of the plan of care.
• Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
• Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• May outreach directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop relevant policies/procedures, education or training for use both internally and externally.

Key Requirements and Technology Experience:

• Must be able to work in a remote environment.
• Case Management
• History of working with electronic medical records.
• Experience working with managed care.
• MCO - Managed Care Organization experience is a plus.
• Bedside experience is a must/hospital experience. (3 years)
• Highly motivated/independent thinker/worker - self starter
• Critical thinking skills
• Ability to adapt to technology/tech savy.
• RN with 3 years of clinical and/or case management experience required.
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
• For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment.

Our client is a leading Health insurance industry, and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.