Case Manager, RN/LCSW

Hbcu Connect, Llc; Oceanside (CA); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health Insurance

Life Insurance

401(k) Matching

Paid Time Off

Education Reimbursement

Licensure Support

Job summary

Maximus is seeking a Case Manager to coordinate services for service members and their families, liaising between military and civilian agencies to ensure continuity of care.

Candidates must be US citizens with an active Secret clearance or eligibility, and the role is contingent on contract award with duties near multiple bases including Camp Pendleton, CA.

Qualifications

• RN license OR LCSW license
• Bachelor's degree with 5-7 years of nursing/case management consulting experience
• Strong professional communication and coordination skills

Responsibilities

• Review favorable determinations and render medical necessity determinations for Medicare State East cases.
• Coordinate care and documentation pathways between military and civilian agencies.
• Serve as SME for project and liaison for military health system stakeholders.
• Perform general research or special projects as needed and manage assigned cases.

Skills

RN License

LCSW

Security clearance

Communication

Case management

Education

Bachelor's degree

Job description

The Case Manager provides comprehensive coordination of services for service members and their families. This role coordinates patient care and documentation pathways and serves as a liaison between military and civilian medical and non-medical agencies to support continuity of care. The RN Case Manager conducts assessments, planning, and evaluation of care to promote optimal health and support successful transitions back to duty or into the civilian community.

Candidates must live in or near Camp Pendleton, CA; Coronado, CA; Cannon AFB, NM; Dam Neck, VA; JEB Little Creek, VA; Fort Benning, GA; Fort Bragg, NC; Fort Campbell, KY; Fort Carson, CO; Joint Base Lewis-McChord, WA; Homestead AFB, FL; Hurlburt Field, FL; Eglin AFB, FL; or MacDill AFB, FL.

U.S. citizenship is required. Candidates must possess an active U.S. Government Secret security clearance or be eligible to obtain and maintain a Secret security clearance as required for contract performance. This position is pending upon contract award.

Why Maximus?

• Flexibility That Fits Your Life âEUR" Work/life balance support with flexibility designed to meet your personal and professional needs.
• Robust Health & Insurance Benefits Choose from a variety of Medical, Dental, Vision, and Prescription plans, plus a partially funded HSA. YouâEUR(TM)ll also have access to Life Insurance and discounts on Auto, Home, Renters, and Pet Insurance.
• Build Your Financial Future Take advantage of our 401(k) Retirement Savings Plan with Company Match to help you plan for what's ahead.
• Generous Time Away From Work Recharge with PTO, paid holidays, extended sick leave, and Short and Long Term Disability coverage.
• Wellness Beyond the Workplace Access resources that support your physical, emotional, and financial well-being through our Employee Assistance Program (EAP).
• Recognition That Matters Celebrate achievements and recognize colleagues through our employee recognition platform.
• Invest in Your Growth Continue your education and professional development with Tuition Reimbursement opportunities.
• Employee Discounts & Perks Enjoy exclusive savings, special offers, and additional employee-only benefits.
• Wellness Programs & Resources Explore a variety of programs and tools designed to support your overall health and wellness.
• Career Development Opportunities Enhance your skills through training programs, workshops, conferences, and ongoing learning opportunities.
• Licensure & Certification Support Maximus covers the costs associated with renewing required licenses and certifications.

Essential Duties and Responsibilities

• Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
• Render medical necessity determinations for Medicare State East cases assigned.
• Resolve all other technical issues within Medicare reconsideration assigned.
• Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
• May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
• Be the Subject Matter Expert (SME) for project.
• Perform other duties as assigned by management.

Minimum Requirements

• Bachelor's degree with 5-7 years of experience consulting within designated function.
• Advanced degree preferred.
• Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
• Ensure solutions are consistent with organization objectives.
• Solutions may serve as precedent for future decisions.
• Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
• Develop new applications based on professional principles and theories.
• Viewed as expert in field within the organization.
• Active RN license OR Active Licensed Clinical Social Worker (LCSW) license with a minimum two (2) year nursing degree from an accredited institution.
• Minimum of (2) years of nursing and/or case management experience.
• Certification as a case manager by a recognized certifying organization, such as the Commission for Case Manager Certification, American Case Management Association, or American Nurses Credentialing Center; or ability to obtain certification within one (1) year of hire.
• Professional oral and written communication skills with peers, outside agencies, vendors, providers, and Military Health System stakeholders.
• Skill in team coordination, facilitation, and communication to support information exchange, goal achievement, client support networks, and change in systems or policies.

Preferred Requirement

• Licensed Clinical Social Worker (LCSW) licensure

Home Office Requirements

• Maximus provides company-issued computer equipment
• Reliable high-speed internet service
• Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
• Minimum 5 Mpbs upload speeds

EEO Statement

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory