Medical Case Manager - Delaware
Core
Provide comprehensive case management services to members with moderate complexity health needs, assessing needs, developing care plans, and coordinating services to ensure quality, cost-effective care delivery.
Role type
Senior IC medical case manager
Builds
Individualized care plans and coordinated service delivery for health plan members
Domain
Health insurance / Managed care
Required skills
Care planning, case management, health status assessment, care coordination, referral management, progress monitoring, cost containment, regulatory compliance, documentation
Preferred skills
Chronic condition management, behavioral health/substance use disorders, pediatrics, intellectual/developmental disorders, Medicaid/Medicare experience, cultural competency
Technologies
Electronic health records (EHR), case management software, Microsoft Office
Responsibilities
Manage a caseload of members with moderate complexity health needs; Assess members' health status, needs, and available resources; Develop individualized care plans in collaboration with members, physicians, and other healthcare providers; Coordinate referrals to specialists and community resources; Monitor member progress toward goals and adjust care plans as needed; Identify areas for potential cost savings, quality improvement and workflow efficiencies.
Seniority
Mid-level, hands-on IC