Case Manager (CCM)

Oscar Health; United States; Remote; USD 68,000 - 99,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

11 paid holidays

Paid sick time

Parental leave

401(k) plan participation

Life and disability insurance

Paid wellness time

Job summary

Oscar Health is hiring a Case Manager to join our Complex Case Management team in a remote role. The position focuses on educating members, evaluating SDOH, and connecting individuals with community resources to improve outcomes.

Applicants should have 2+ years in care management, experience with chronic conditions, and relevant licenses/certifications. Travel may occur for meetings and events, with pay transparency by state and strong benefits.

Qualifications

• 2+ years of clinical experience in hospital, outpatient, or community-based care management.
• 2+ years of experience working directly with patients with chronic conditions (e.g., diabetes, COPD, hypertension).
• 1+ years experience in Care Coordination and Navigation.
• Active, unrestricted RN license from the US in state or active compact multistate license or MSW from a CSWE-accredited program.

Responsibilities

• Coordinate care across inpatient, outpatient, ER, or home care while maintaining confidentiality and high professional standards.
• Partner with members and providers to navigate complex health challenges and create personalized care plans that improve outcomes.
• Assess and address Social Determinants of Health (SDOH) by connecting members with community resources.
• Provide crisis intervention support and advocate to resolve barriers to care and treatment compliance.
• Engage with members by phone, secure messaging, or in-person to educate on health conditions and procedures.
• Compliance with all applicable laws and regulations.
• Other responsibilities as assigned.

Skills

Care coordination

Patient education

SDOH assessment

Crisis intervention

Advocacy

Education

RN licensure (US) or MSW (CSWE)

BSN

LMSW or LCSW

CCM Certification

Complex Case Management certification

Job description

Hi, we're Oscar. We're hiring a Case Manager to join our Complex Case Management team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Case Manager collaborates across Oscar teams to deliver high-quality care and improve member health outcomes. In this role, the Case Manager will educate members, evaluate Social Determinants of Health (SDOH), and connect individuals with community resources while contributing to process improvement initiatives and new pilot programs as required.

You will report into our Manager, Clinical Programs.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio;Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $75,348 - $98,894 per year. The base pay for this role in all other locations is: $67,813- $89,005. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Coordinate care across settings (inpatient, outpatient, ER, or home care) while maintaining strict confidentiality and high professional standards.
• Partner with members and providers to navigate complex health challenges and create personalized care plans that create better clinical outcomes.
• Assess and address Social Determinants of Health (SDOH) by connecting members with tailored community support resources.
• Provide crisis intervention support and act as a dedicated member advocate to resolve barriers to care and treatment compliance.
• Engage directly with members by phone, secure messaging, or in-person, to provide education on health conditions, hospital discharges, medical procedures, and new prescriptions.
• Compliance with all applicable laws and regulations.
• Other responsibilities as assigned.

Requirements:

• 2+ years of clinical experience to include hospital, outpatient or community-based care management.
• 2+ years of experience working directly with patients with chronic medical conditions (e..g diabetes, COPD, hypertension), demonstrating a solid understanding of disease trajectories, common treatment regimens, and symptom management.
• 1+ years experience Care Coordination and Navigation.
• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license or Masters in Social Work (MSW) from a graduate of a Nationally Accredited School approved by the Council on Social Work Education.
• BSN
• Licensed Master Social Worker or Licensed Clinical Social Worker
• CCM Certification
• Complex Case Management certification

This is an authentic Oscar Health job opportunity.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy .

The work location expectations for this role is listed in the job postings under “Work Location”. This section includes any onsite related expectations and residency requirements.

Oscar Health is authorized to do business in many, but not all, states. If you are not located in or willing to relocate to a state where Oscar is registered, you will not be eligible for employment. The approved states for this role are listed in the job posting.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Oscar Health's Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.