About this role
Role Overview
- Conduct thorough assessments of members’ health status, medical history, and social determinants of health to develop personalized care plans.
- Coordinate with physicians, specialists, and other healthcare professionals to ensure timely and effective delivery of medical services.
- Monitor member adherence to prescribed treatments and medications, providing education and support to encourage compliance.
- Identify and address potential gaps in care, including arranging for additional services such as home health, rehabilitation, or community resources.
- Maintain detailed documentation of care plans, member interactions, and outcomes in compliance with regulatory and organizational standards.
Requirements
- Bachelor’s degree in Nursing, Social Work, Public Health, or a related healthcare field.
- Current and valid professional licensure or certification relevant to care management (e.g., RN, LCSW).
- Minimum of 3 years’ experience in case management, care coordination, or a related healthcare role.
- Strong knowledge of Medicare Advantage programs, healthcare regulations, and care management best practices.
- Proficiency in electronic health records (EHR) systems and care management software.
- Relevant experience may substitute for the educational requirement on a year-for-year basis.
- Master’s degree in Nursing, Social Work, Public Health, or a related healthcare field (preferred).
- Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification (preferred).
- Experience working specifically with Medicare Advantage populations (preferred).
- Advanced degree in healthcare administration, nursing, or social work (preferred).
- Familiarity with population health management and quality improvement methodologies (preferred).
- Bilingual abilities to effectively communicate with diverse member populations (preferred).