RN Case Manager or LCSW-C

Johns Hopkins Medicine; Maryland; Hybrid; USD 61,000 - 94,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

403B Savings Plan

Generous Paid Time Off

Wellness programs

Job summary

Johns Hopkins Health Plans seeks a Case Manager to coordinate care for patients with chronic conditions and high-cost needs. You will anticipate changes, coordinate services, and document outcomes to meet patient goals within planned timelines.

The role requires clinical nursing expertise with Maryland licensure and strong collaboration across care teams. Remote work is offered with competitive benefits.

Qualifications

• Registered nurse licensure in Maryland or LCSW-C in Maryland.
• Case management knowledge and disease management exposure.
• Experience with utilization management and quality improvement processes.

Responsibilities

• Identify and act on changes in patient condition.
• Analyze staff/patient/systems issues impacting care plan.
• Initiate corrective actions and review financial reports.
• Maintain budgeted caseload and apply established guidelines.
• Decide work processes using negotiation and available resources.

Skills

Clinical expertise

Health care knowledge

Communication skills

Negotiation principles

Team-oriented work

Budget management

Education

Bachelor's degree in nursing or related field

Tools

None

Job description

Excel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion.

Make It Happen At Hopkins!

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institution in the United States.JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments.JHHP has become a leader in provider-sponsored health plans and is poised for future growth.

About this position:

Work Schedule: Monday - Friday, the core business hours are 8:00 AM - 5:00 PM

What awaits you:

• Work-life balance -This is a remote role.
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Generous Paid Time Off
• Health and wellness programs and MORE!

Who you are:

The Case Manager anticipates and coordinates care/services/health education for targeted patient populations with chronic disease conditions or high-cost specialty care. She/he demonstrates knowledge of case and disease management, prognosis, and outcomes, and is responsible for ensuring that patient goals are achieved within a specified time period based upon individual needs, reasonable expectations, and well-documented outcomes.

What you’ll do:

• Identifies and acts upon impending changes in patient condition.
• Identifies and analyzes staff/patient/system issues that impact the plan of care.
• Initiates corrective action.
• Reviews/interprets patient population-specific financial reports.
• Maintains budgeted caseload
• Makes decisions regarding work processes based on established guidelines.
• Understands and uses principles of negotiation.
• Effectively uses resources within control.
• May assign work to support staff

What you’ll bring:

• Demonstrated clinical expertise in acute care nursing with clinical expertise in a specialty area preferred.
• Knowledge of health care and managed care delivery systems.
• Standards of medical practice.
• Insurance benefit structures and related legal/ medical issues.
• Utilization management and quality improvement processes.
• Community resources.
• Ability to work in a dynamic, team-oriented environment and demonstrate positive relationship building.
• Effective verbal/ written communication.
• Ability to affect change.
• Ability to perform critical analysis, plan and organize effectively.
• Ability to promote patient/family autonomy.
• Business acumen so that health benefits and patient/provider satisfaction are maximized while solidifying the program’s viability through cost effective intervention.

Education:

• Bachelor’s degree in nursing or related years of experience, or MSW in social work preferred.

Work Experience:

• Minimum five (5) years clinical practice.
• Minimum three (3) years clinical practice in a specific specialty.
• Additional case management/ disease management or managed care experience preferred.

Licensure:

• Current registered nurse licensure in the state of Maryland or LCSW-C.
• Certification in case management (CCM) preferred.

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.

Salary Range: Minimum $43.61/hour - Maximum $67.59/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.