Case Manager, RN/LCSW (POTFF)

Maximus; Oceanside (CA); On-site; USD 74,000 - 106,000; Full time

Benefits offered by this job

Health insurance

401(k) match

Paid time off

Tuition reimbursement

Life Insurance

Disability insurance

Job summary

Maximus is seeking an RN Case Manager in Oceanside, CA to coordinate comprehensive care for service members and their families, interfacing with military and civilian agencies to ensure continuity of care and successful transitions back to duty or civilian life.

The role includes assessments, care planning, and documentation, while adhering to federal guidelines and maintaining required security clearance for contract work.

Qualifications

• Active U.S. citizenship required.
• Active U.S. Government Secret security clearance or eligibility required.
• Ability to coordinate care across military and civilian agencies.

Responsibilities

• Review favorable determinations and render medical necessity determinations for Medicare State East cases.
• Coordinate case reviews, summarize facts, and assess issues involved in each case.
• Serve as SME for project and liaise for special projects when needed.
• Demonstrate knowledge of clinical guidelines and pharmaceutical considerations to aid client care.

Job description

Description & Requirements

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 should be able to support operations at one or more of the following locations: 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.

General information

Date Tuesday, September 15, 2026

City Oceanside

State CA

Country United States

Working time Full-time

Why Maximus?

Flexibility That Fits Your Life – 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. You’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.
• Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
• Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
• Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
• Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
• Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
• Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
• Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
• Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
• Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
• Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.

#MaxHP #maxcleared #SPC26

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 minimum wage rates and exempt salary thresholds in all instances.

Accommodations

Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process—including accessing job postings, completing assessments, or participating in interviews,—please contact People Operations at [e-mail].

Minimum Salary

$ 73,950.00

Maximum Salary

$ 105,850.00