Case Manager Long-term Care Delaware (New Castle County and Kent County)

Highmark Health; New York (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company is seeking a Case Manager for Long-term Care to coordinate care for members in various settings. This full-time role involves assessing needs, developing care plans, and collaborating with healthcare teams. The position requires travel within Delaware and offers a remote work setup with flexible hours.

Qualifications

• 3 years' experience in case management with Bachelor's degree.
• 1 year of experience with Master's degree or 2 years as RN/LPN.

Responsibilities

• Coordinate care for members with complex health needs.
• Travel to members' homes for assessments and follow-ups.
• Document all services and interventions in electronic health record.

Skills

Cultural Competency

Budgeting Skills

MS Office

Electronic Documentation

Ability to Meet Deadlines

Reliable Transportation

Flexible Hours

Education

Bachelor's in Social Work

Master’s in Social Work

High School Diploma

Registered Nurse

Licensed Practical Nurse

Job description

Thank you for your interest in employment at a Highmark Health company. Highmark Health uses an online application process. If you participate in the online application process through this Workday site, your personal information will be collected, including but not limited to data such as your resume and resume content, education, contact information, address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide. We will inform you how we will use this data and where it is processed, and we will seek your consent to use it in accordance with the Highmark Health Data Protection Statement and GDPR Data Protection Consent for Job Applicants.

Job Title: Case Manager Long-term Care Delaware (New Castle County and Kent County)

Company: Highmark Inc.

Job Description:

JOB SUMMARY

This role acts as the primary contact for members, coordinating their care across service systems and community supports. It is a full-time, community-based position requiring frequent travel within DE, including visits to members’ homes, nursing facilities, and community settings for individuals enrolled in DSHP Plus LTSS.

ESSENTIAL RESPONSIBILITIES

• Travel to members' homes and community settings for face-to-face needs assessments, followed by telephonic follow-ups, adhering to guidelines and protocols.
• Assess, plan, coordinate, implement, and evaluate care for members with complex health, social, and custodial needs in various settings.
• Coordinate care across services, assisting with physical, behavioral, and social needs in the safest and most cost-effective manner.
• Facilitate authorization, continuity, and appropriateness of care and services in community or HCBS settings.
• Support transitions between care settings, such as hospital to home or nursing facility to community.
• Educate members and caregivers about health needs, benefits, resources, and options for long-term care.
• Develop and revise care plans in collaboration with members or caregivers to meet their needs and goals.
• Identify and facilitate access to resources and specialized programs as needed.
• Collaborate with healthcare teams to coordinate care and community resources, aiming to keep members in the least restrictive environment.
• Assist in developing backup plans for provider coverage gaps.
• Ensure services are provided as outlined in care plans and evaluate their effectiveness, making revisions as necessary.
• Help members overcome obstacles by connecting them with community resources and communicating with providers.
• Document all services and interventions in the electronic health record.
• Comply with privacy, HIPAA, and quality standards.
• Perform additional duties as assigned.

QUALIFICATIONS

Required:

• Bachelor's in Social Work or related field with 3 years' experience, OR
• Master’s in Social Work or related field with 1 year' experience, OR
• Registered Nurse or Licensed Practical Nurse with 2 years' experience, OR
• High school diploma with 3 years’ case management experience with the elderly or disabled populations.

Preferred:

• Experience in home clinical or case management, CCM, LBSW, LMSW, LCSW certifications, or working with specific populations (HIV/AIDS, behavioral health, developmental disabilities), Medicare/Medicaid, managed care experience.

Skills

• Flexible hours, reliable transportation, proficiency in MS Office, ability to meet deadlines, dedicated home workspace, experience with electronic documentation, budgeting skills, cultural competency.

Additional Details

Travel requirement: 25-50%. Position is remote, with physical demands including lifting up to 50 pounds occasionally. Adherence to all legal, privacy, and ethical standards is mandatory.