RN Care Manager - Telephonic Case Management

SGS Consulting; Elm (PA); On-site; USD 85,000 - 120,000; Full time

Job summary

SGS Consulting seeks an experienced Registered Nurse licensed in Pennsylvania to lead clinical care for members with complex health needs, providing coaching and intensive case management via telephonic contact.

You will develop care plans, coordinate with treating providers, connect members with community resources, and ensure documentation meets regulatory standards while supporting transitions and benefit navigation.

Qualifications

• Licensed RN in PA
• Certified Case Manager
• 5+ years of relevant experience
• Disease management knowledge or experience
• Prior experience in case management and managed care
• Knowledge of assessments and care plans
• Experience with community resources
• Knowledge of preventive health services
• 1-800-line experience preferred
• Experience with Medicaid populations
• Able to work independently
• Telephonic outreach to members
• Excellent verbal and written communication skills

Responsibilities

• Function as primary clinician for members with complex health needs and support self-management and navigation of health care.
• Conduct telephonic clinical assessments addressing health and wellness needs to effect self-management and positive behavior changes.
• Develop plans of care using clinical information systems to establish short- and long-term goals.
• Establish regular telephonic contact with members to review progress and assess additional needs.
• Communicate with treating providers in complex cases; educate and train clinicians as needed.
• Identify online, telephonic and community resources to help members achieve health goals.
• Incorporate lifestyle improvement and prevention opportunities into member interactions and coaching.
• Ensure all activities are documented and compliant with regulatory and accreditation standards.
• Coordinate with Blue Distinction Centers for Transplant Excellence when applicable.
• Collaborate with Benefits Analysts to interpret benefits language and manage appeals/denials and claims processing.

Skills

RN license PA

Case management

Disease management

Certified Case Manager

Managed care

Assessments

Resource coordination

Telephonic outreach

Medicaid experience

Independent worker

Verbal/written communication

Education

PA RN license

Certified Case Manager

Job description

SGS Consulting seeks an experienced Registered Nurse licensed in Pennsylvania to lead clinical care for members with complex health needs, providing coaching and intensive case management via telephonic contact.

You will develop care plans, coordinate with treating providers, connect members with community resources, and ensure documentation meets regulatory standards while supporting transitions and benefit navigation.