About the Company
We are a nationally recognized healthcare management and digital health organization dedicated to improving the quality, accessibility, and coordination of care for millions of members across the United States. Through advanced care management technology, data analytics, telehealth solutions, and personalized member support, we partner with healthcare providers, insurance organizations, employers, and government agencies to deliver better health outcomes while reducing the overall cost of care.
Our organization believes that every individual deserves personalized guidance throughout their healthcare journey. As healthcare continues to evolve toward value-based care and integrated health services, we are expanding our Care Management team to provide compassionate, evidence-based support that empowers members to achieve healthier lives.
We are seeking an experienced Case Manager to coordinate comprehensive care plans, advocate for members, and facilitate access to appropriate healthcare services and community resources. This role serves as a trusted resource for patients, providers, caregivers, and interdisciplinary care teams while ensuring every member receives timely, coordinated, and high-quality support.
The Case Manager collaborates closely with Physicians, Nurses, Behavioral Health Specialists, Pharmacists, Social Workers, Utilization Management, Customer Service, and Community Partners to develop individualized care strategies that improve clinical outcomes, member satisfaction, and overall quality of life.
This opportunity is ideal for compassionate professionals who are passionate about improving patient outcomes, coordinating complex care, and making a meaningful impact within an innovative healthcare organization.
Essential Duties and Responsibilities
- Assess members’ healthcare needs and develop individualized care management plans.
- Coordinate medical, behavioral health, pharmacy, and community services to ensure continuity of care.
- Collaborate with physicians, healthcare providers, caregivers, and interdisciplinary teams to support treatment plans.
- Monitor member progress and adjust care plans based on clinical needs and healthcare outcomes.
- Educate members regarding treatment options, preventive care, wellness programs, and available healthcare resources.
- Facilitate referrals to specialists, rehabilitation programs, home health services, behavioral health providers, and community organizations.
- Maintain accurate case documentation in electronic health record (EHR) and care management systems.
- Ensure compliance with HIPAA, CMS regulations, NCQA standards, and organizational policies.
- Support hospital discharge planning and transitions of care initiatives.
- Identify barriers to care and implement solutions that improve healthcare access and patient engagement.
- Participate in quality improvement initiatives and population health management programs.
- Monitor performance metrics, care outcomes, and member satisfaction indicators.
- Maintain current knowledge of healthcare regulations, clinical guidelines, and case management best practices.
- Participate in interdisciplinary case conferences and ongoing professional development.
Job Qualifications and Requirements
- Bachelor’s degree in Nursing, Social Work, Healthcare Administration, Psychology, Public Health, or a related healthcare discipline required.
- Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), or equivalent clinical license is preferred where applicable.
- Minimum of 3 years of experience in case management, care coordination, healthcare services, behavioral health, or clinical operations.
- Experience working with electronic health records (EHR), care management software, and healthcare documentation systems.
- Strong understanding of healthcare delivery systems, utilization management, discharge planning, and care coordination.
- Knowledge of Medicare, Medicaid, commercial insurance, and healthcare regulatory requirements.
- Certified Case Manager (CCM), ACM, or equivalent certification is highly preferred.
- Excellent communication, assessment, and relationship management skills.
- Ability to manage multiple complex cases while maintaining quality and compliance standards.
Personal Capabilities and Qualifications
The successful Case Manager combines clinical knowledge with compassion, critical thinking, and exceptional communication skills. They build trusted relationships with members and healthcare professionals while advocating for high-quality, patient-centered care.
Ideal candidates possess:
- Strong clinical assessment and care coordination skills.
- Excellent communication and interpersonal abilities.
- Outstanding empathy and patient advocacy.
- Strong organizational and documentation skills.
- Critical-thinking and problem-solving capabilities.
- Close attention to detail and regulatory compliance.
- Ability to manage multiple priorities in a fast-paced healthcare environment.
- Professional integrity and confidentiality.
- Collaborative approach to interdisciplinary teamwork.
- Commitment to improving health outcomes and member satisfaction.
Strategic Support
As a member of the Care Management organization, the Case Manager provides strategic support by:
- Improving patient outcomes through coordinated care management.
- Reducing avoidable hospital admissions and readmissions.
- Supporting population health and preventive care initiatives.
- Strengthening collaboration across healthcare providers and community resources.
- Enhancing member engagement and healthcare accessibility.
- Supporting regulatory compliance and quality improvement programs.
- Improving operational efficiency through effective care coordination.
- Contributing to organizational goals focused on value-based healthcare delivery.
Working Conditions
- Fully Remote position within the United States.
- Standard business hours with occasional flexibility to support member needs across multiple U.S. time zones.
- Company-provided laptop, secure healthcare systems access, and home office technology support.
- Collaborative, mission-driven environment focused on compassionate care, innovation, and continuous improvement.
- Approximately 5–10% domestic travel for training, clinical meetings, and organizational events when required.
Job Function
The Case Manager is responsible for assessing member needs, coordinating healthcare services, developing individualized care plans, and supporting positive clinical outcomes through comprehensive care management. This role partners with healthcare providers, interdisciplinary teams, and community organizations to ensure members receive high-quality, cost-effective, and patient-centered care. Success is measured through improved health outcomes, care plan effectiveness, regulatory compliance, member satisfaction, and operational excellence.
Compensation & Benefits
Compensation Package
Base Salary: $188,000 – $258,000 USD annually
Compensation is determined based on clinical experience, case management expertise, certifications, geographic location, and overall qualifications.
Eligible employees may also receive:
- Annual Performance Bonus
- 401(k) with Company Match
- Comprehensive Medical, Dental, and Vision Insurance
- Flexible Paid Time Off
- Paid Company Holidays
- Paid Parental and Family Leave
- Professional License Renewal and Certification Reimbursement
- Continuing Education and Tuition Assistance
- Home Office and Technology Stipend
- Employee Assistance Program (EAP)
- Wellness and Mental Health Benefits
- Life and Disability Insurance
- Career Advancement and Leadership Development Opportunities
Why Join Us
Healthcare is most effective when every individual has an advocate guiding them through their care journey. As a Case Manager, you’ll play a meaningful role in helping members access the services, education, and support they need to improve their health and quality of life.
You’ll work alongside dedicated healthcare professionals, clinicians, and care coordinators within a collaborative organization that values compassion, innovation, and continuous learning. We invest in our employees through professional development, advanced technology, and opportunities for career growth while empowering you to make a lasting difference in the lives of the people and communities we serve.
If you’re passionate about patient advocacy, care coordination, and improving healthcare outcomes, we encourage you to apply and become part of our Care Management & Member Services team.
