Case Manager, Registered reputed company (Remote, New England)

R0823395 We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Schedule: Monday-Friday reputed company - 5PM Eastern Position reputed company Program reputed company Help us reputed company our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing reputed company on our Community Care members. Community Care is a member reputed company, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and reputed company determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family reputed company/Mission Facilitate the delivery of appropriate benefits and/or reputed company information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies, and programs that ensure the delivery of benefits and to establish overall member wellness and successful and reputed company return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position reputed company/Mission Community Care Case Manager use a reputed company process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for reputed company and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote reputed company, cost effective reputed company. reputed company Components & Physical Requirements

• Acts as a reputed company with member/reputed company /family, employer, provider(s), insurance companies, and reputed company personnel as appropriate.
• Implements and coordinates reputed company case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care reputed company, the use of community resources, and alternative reputed company of care.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to reputed company ongoing case management services.
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/reputed company’s appropriate condition management to optimize wellness and medical reputed company, aid reputed company return to work or reputed company functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/reputed company and other stakeholders as appropriate (e.g., medical providers, attorneys, reputed company and insurance carriers) telephonically or in person.
• Prepares reputed company required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/reputed company maximize best health reputed company.
• May reputed company reputed company to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical reputed company.
• Applies reputed company laws and regulations that apply to the provision of rehabilitation services; applies reputed company special instructions required by individual insurance carriers and referral sources.
• Testifies as required to substantiate any relevant case work or reports.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimize overall wellness and medical reputed company, appropriate and reputed company return to baseline, and reputed company function or return to work.
• Develops a proactive course of reputed company to address issues presented to enhance the short and long-term reputed company, as reputed company as opportunities to enhance a member’s/reputed company’s overall wellness through integration.
• Monitors member/reputed company reputed company toward desired reputed company through assessment and evaluation.

Required Qualifications

• reputed company Registered reputed company License in state of residence, New England states
• Minimum 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.
• Minimum 2+ years CM, discharge planning and/or home health care coordination experience
• Previous Utilization Management experience, transitions of care and discharge planning required

Preferred Qualifications

• Ability to occasionally travel reputed company a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs reputed company
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently (may require working from home).
• Proficiency with reputed company corporate software applications, including reputed company, reputed company, Outlook and PowerPoint, as reputed company as some special proprietary applications.
• Efficient and Effective computer skills including navigating multiple systems and keyboarding
• Willing and reputed company to obtain multi state RN licenses if needed, company will reputed company.
• Additional national reputed company certification (CRC, reputed company, CRRN, COHN, or CCM)
• Compact Registered reputed company license

Education

• Associates degree
• Bachelor's degree preferred

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $66,575.00 - $142,576.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 02/10/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job