Case Manager

Immediate need for a talented Case Manager. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-85909

Pay Range: $35 - $38/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with  members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or  discharge planning.
• Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs;
• Identify barriers to meeting goals or plan of care
• Utilize community resources and funding sources as needed in the development of the plan of care.
• Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion  of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation,  assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation  unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
• Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• May outreach directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop relevant policies/procedures, education or training for use both internally and externally.
   

Key Requirements and Technology Experience: 

• Key skills; Experience working with 65+ patients (CKD, Diabetes, Hypertension) in hospital setting
• Active RN license
• Case management experience
• Tech Savy and able to use the BC system Medicare exp
• Hospital experience all or any (Parkinsons Disease G20, Multiple Sclerosis G35, Myasthenia Gravis G70 or G70.0,
• Amyotrophic Lateral Sclerosis G12.21, Sickle Cell Anemia D57, D57.0 or D57.1, Hemophilia D68.311, Cystic Fibrosis E84, E84.0 to E84.9) experience working with 65+ (CKD, Diabetes, Hypertension.
  
   

Our client is a leading Health Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy