Medical Case Manager - PDN/Private Duty Nursing (Delaware)
Core
Full-time case manager providing comprehensive case management services to members with moderate complexity health needs, ensuring quality, cost-effective care delivery, and promoting optimal health outcomes.
Role type
Senior IC case manager (utilization management)
Builds
Individualized care plans and coordinated service delivery for health plan members
Domain
Health insurance / Utilization management
Required skills
Care planning, care coordination, member assessment, provider liaison, cost containment, regulatory compliance, data documentation
Preferred skills
Pediatric experience, Medicaid/Medicare experience, cultural competency, bilingual English/Spanish
Technologies
Electronic health records (EHR), case management software, Microsoft Office
Responsibilities
Assess members' health status and needs; develop and implement individualized care plans; coordinate referrals to specialists and community resources; monitor member progress and adjust care plans; evaluate intervention effectiveness; identify areas for cost savings and workflow efficiencies.
Seniority
Mid-level, hands-on IC