Case Manager Long-term Care - Delaware, New Castle County - RN

Highmark Health Company; New York (NY); Hybrid; USD 73,000 - 117,000; Full time

Job summary

Highmark Health is seeking a Registered Nurse Case Manager for the New Castle County territory to deliver comprehensive case management to DSHP Plus LTSS and DSNP members. The role requires frequent travel within the territory for home or site visits to assess needs, develop and implement care plans, and coordinate services to optimize outcomes and costs.

You will advocate for members, monitor progress, and ensure regulatory compliance while maximizing benefits.

Qualifications

• Bachelor's degree in Social Work or health/education services.
• Master's degree in Social Work or health/education services with 1 year in related fields.
• RN or LPN licensure or eNLC with 2 years in long-term care or home health.
• Substitutions None
• Preferred 1 year in home clinical or case management
• Certified Case Manager (CCM)
• Licensed Bachelors Social Worker (LBSW)
• Licensed Masters Social Worker (LMSW)
• Licensed Clinical Social Worker (LCSW)
• Experience with HIV/AIDS, behavioral health, and developmental disabilities
• Medicare/Medicaid and managed care experience

Responsibilities

• Comprehensive member assessment through in-person visits and ongoing support.
• Develop, implement, and monitor individualized care plans.
• Coordinate access to services and specialists across settings.
• Advocate for members and caregivers to navigate decisions.
• Ensure seamless care transitions between sites and facilities.
• Monitor progress and adjust plans to optimize outcomes.
• Identify opportunities for cost savings and quality improvement.
• Ensure documentation complies with policies and regulations.
• Coordinate benefits and prevent improper utilization.
• Perform other duties as assigned

Skills

Assessment

Care planning

Independent work

Teamwork

MS Office

EHR

Time management

Care management

Education

Bachelor's degree in Social Work or health/education services

Master's degree in Social Work or health/education services

RN or LPN licensure OR multi-state licensure (eNLC) with 2 years experience

Job description

Company : Highmark Inc.

Job Description :

JOB SUMMARY

New Castle County territory - Registered Nurse

This community-based Case Manager position is responsible for delivering comprehensive case management services to DSHP Plus LTSS and DSNP members. The role requires frequent travel within an assigned territory for home or site visits to assess member needs, develop and implement care plans, evaluate benefits, coordinate services, and monitor progress. A key aspect of the position is to ensure quality and cost-effective care by preventing improper utilization of member benefits.

ESSENTIAL RESPONSIBILITIES

• Comprehensive Member Assessment: Conduct thorough assessments of members' health status, needs, and resources through in-person visits and ongoing phone support, managing a caseload with moderate complexity.


• Individualized Care Plan Management: Develop, implement, and monitor individualized care plans that address physical, behavioral, custodial, social, and psychosocial needs with minimal guidance.


• Holistic Service Coordination: Coordinate access to appropriate services, community resources, and specialists, ensuring efficient and cost-effective delivery across care settings.


• Member Advocacy: Serve as a primary advocate, guiding members and caregivers through healthcare decisions, and helping them overcome barriers to achieve care plan goals.


• Care Transition & Continuity: Ensure seamless and appropriate care transitions between hospitals, community settings, and facilities.


• Outcome Evaluation: Continuously monitor member progress, evaluate the effectiveness of services, and proactively adjust care plans to optimize outcomes.


• Cost & Quality Improvement: Identify opportunities for cost savings, quality improvement, and workflow efficiencies in care delivery.


• Regulatory Adherence: Ensure all documentation and activities strictly comply with business processes, company policies, regulatory requirements, and accreditation standards.


• Benefit Maximization: Coordinate member benefits across all payor sources and actively work to prevent improper utilization of benefits.


• Perform other duties as assigned/requested.

QUALIFICATIONS

• RequiredBachelor's degree in Social Work or in health, human, or education services and 3 years of experience in long-term care, home health, hospice, public health, or assisted living


• ORMaster's degree in Social Work or in health, human, or education services and 1 year of experience in long-term care, home health, hospice, public health, or assisted living


• ORCurrent State RN or LPN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) and 2 years of experience in long-term care, home health, hospice, public health, or assisted living.


• SubstitutionsNone


• PreferredOne year in home clinical or case management experience


• Certified Case Manager (CCM)


• Licensed Bachelors Social Worker (LBSW)


• Licensed Masters Social Worker (LMSW)


• Licensed Clinical Social Worker (LCSW)


• Experience working with HIV/AIDS population


• Experience working with behavioral health population


• Experience working with developmental disabilities population


• Medicare and Medicaid experience


• Managed care experience

SKILLS

• Strong assessment and care planning skills.Ability to work independently and as part of a team.Proficiency in using Microsoft suite of applications, case management software and electronic health records.Time management abilitiesUnderstanding of healthcare systems and case management principles

Language (Other than English):None

Travel Requirement:25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

• Position TypeWorks From Home


• Teaches / trains others regularlyOccasionally


• Travel regularly from the office to various work sites or from site-to-siteOccasionally


• Works primarily out-of-the office selling products/services (sales employees)Never


• Physical work site requiredYes


• Lifting: up to 10 poundsConstantly


• Lifting: 10 to 25 poundsOccasionally


• Lifting: 25 to 50 poundsRarely

Disclaimer:

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. #IND456

Pay Range Minimum:$72,700.00

Pay Range Maximum:$116,600.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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