Case Manager

Job Title: Case Manager - USC only Location: Remote but must be located in PA, prefer local to Pittsburgh, PA Job Description:The information below covers the role requirements, expected candidate experience, and accompanying qualifications.The Pediatric Shift Care Case Manager plays a crucial role in supporting pediatric members and their families who are receiving in-home nursing and aide care (Shift Care services). They act as a central point of contact, handling case management, needs assessment, resource coordination, and benefit-related inquiries.Responsibilities: Function as a primary clinician for pediatric members with complex health needs with the depth of engagement ranging from basic coaching to intensive case management. Conduct telephonic clinical assessments that address the health and wellness needs of the organization's members using a broad set of clinical and motivational interviewing skills with the goal of providing resources to the member and family. Develop case or condition-specific plans of care using the clinical information system to establish short and long-term goals. Establish a plan for regular telephonic contact with each member to review progress and assess the potential for additional needs. Communicate with the member's treating provider and Home Health Agency on a regular basis. The CM also serves as a subject matter expert to clinicians from other HMS teams to provide education, consultation, and training when indicated. Identify on-line, telephonic and community-based resources that can assist the member to achieve and maintain their personal health goals and assists the member to access those services. Proactively incorporate lifestyle improvement and prevention opportunities into member interactions and coaching. Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Complete periodic face-to-face visits within the community for the most complex members that would benefit from an in-person meeting.Must have: 5+ years of relevant experience Must be a current licensed RN in the state of PA or be a Licensed Social Worker in PA Prior experience working in case management and managed care Pediatric experience Experience with/familiarity with CPS (Child Protective Services) Knowledge of assessments and care plans Experience with community resources Some knowledge of preventive health services Experience working with the Medicaid population Must have great work ethic Able to work independently Telephonic outreach to members Excellent verbal and written communication skillsPreferred: Individual should be a professionally licensed social worker or nurse Certified Case Manager preferred Bachelor's degree in nursing or RN certification or Master's degree in Social Work and 3 years' experience in Acute or Managed Care/ experience with Medicaid or Medicare populations. OR Case Management Certification

Created: 2025-06-07