Medical Case Manager

Jobtailor; Pennsylvania; On-site; USD 70,000 - 90,000; Full time

Job summary

Jobtailor is seeking a dedicated RN/LCSW-credentialed Case Manager in Pennsylvania to manage a caseload of members with moderate health needs. You will assess, plan, coordinate, and monitor care with healthcare providers, while maintaining compliance and documenting activities in EHRs.

The role emphasizes advocacy, cost-conscious care, and collaboration with a diverse healthcare team. A CCM or RN license and relevant clinical experience are preferred.

Qualifications

• 3 years of experience in clinical, case management, disease condition management, provider operations, and/or health insurance with RN licensure or a Master’s degree.

Responsibilities

• Manage a caseload of members with moderate-complexity health needs.
• Assess members’ health status, needs, and resources.
• Develop individualized care plans with members, physicians, and healthcare providers.
• Implement and coordinate care plans and access to services and resources.
• Coordinate referrals to specialists and community resources.
• Monitor member progress and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate and act as a liaison to meet members’ healthcare needs.
• Promote quality, cost-effective outcomes in accordance with contract benefits.
• Collaborate with physicians, providers, co-workers, and healthcare team members.
• Document activities in compliance with policies and regulatory requirements.
• Identify potential cost savings, quality improvements, and workflow efficiencies.
• Perform other duties as assigned.

Skills

Assessment Skills

Care Planning

Care Coordination

Bilingual English/Spanish

Telephonic Experience

Independent Work

Team Collaboration

Advocacy

Regulatory Compliance

Evidence-based Practice

Education

Bachelor's degree in Nursing

RN licensure

Master’s degree in Social Work or Counseling

Bachelor's degree in Social Work

Certified Case Manager (CCM)

Tools

Case Management Software

Electronic Health Records

Microsoft Office Suite

Job description

• Manage a caseload of members with moderate-complexity health needs
• Assess members’ health status, needs, and available resources
• Develop individualized care plans with members, physicians, and healthcare providers
• Implement and coordinate care plans and access to appropriate services and resources
• Coordinate referrals to specialists and community resources
• Monitor member progress and adjust care plans as needed
• Evaluate the effectiveness of interventions and services
• Advocate and act as a liaison to meet members’ individual healthcare needs
• Promote quality, cost-effective outcomes in accordance with contract benefits
• Collaborate and communicate with physicians, providers, co-workers, and healthcare team members
• Document activities in compliance with business processes, company policies, regulatory requirements, and accreditation standards
• Identify potential cost savings, quality improvements, and workflow efficiencies
• Perform other duties as assigned or requested

Requirements

• 3 years of experience in any combination of clinical, case/utilization management, disease condition management, provider operations, and/or health insurance experience with RN licensure or a Master’s degree
• 5 years’ experience with a Bachelor’s in Social Work
• Bachelor’s degree in nursing or RN licensure or Master’s degree in Social Work, Counseling, or related field, OR Bachelor’s degree in Social Work
• Required professional license/certification: LSW, LPC, LBSW, LCSW, LMSW, LGSW, LCSW, or current State RN licensure, or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
• Strong assessment and care planning skills
• Ability to work independently and as part of a team
• Proficiency in Microsoft Office Suite, case management software, and electronic health records
• Understanding of healthcare systems and case management principles
• Bilingual English/Spanish language skills preferred
• Telephonic experience preferred
• Medicaid managed care and/or Medicare experience preferred
• Experience working with the healthcare needs of diverse populations preferred
• Experience demonstrating understanding of cultural competency preferred
• Certified Case Manager (CCM) preferred
• Must comply with HIPAA, data security guidelines, company policies, legal requirements, and accreditation standards

Core Competencies

Demonstrates strong assessment and care planning skills while managing a caseload of members with moderate-complexity health needs. Proficient in coordinating care plans, collaborating with healthcare teams, and ensuring compliance with regulatory requirements.

Highest-signal resume keywords

• RN Licensure
• Case Management Software
• Assessment Skills
• Care Planning
• Bilingual English/Spanish

ATS Optimization Keywords

Hard Skills

• Care Coordination
• Health Needs Assessment
• Individualized Care Plans
• Monitoring Member Progress
• Evaluating Interventions
• Cost Savings Identification
• Cultural Competency
• Telephonic Experience
• Medicaid Managed Care
• Medicare Experience

Soft Skills

• Team Collaboration
• Independent Work
• Advocacy

Certifications & Qualifications

• Certified Case Manager (CCM)
• LSW
• LPC
• LBSW
• LCSW
• LMSW
LGSW

Industry Keywords

• Healthcare Systems
• Case Management Principles
• Regulatory Compliance
• Accreditation Standards
• Diverse Populations

Tools & Technologies

• Microsoft Office Suite
• Electronic Health Records