Medical Case Manager - Delaware

Apply for Medical Case Manager - Delaware | Careers at Highmark Health Skip to main content Careers Working here Our Companies Career Areas Early CareersInterns Talent Community Team Member Stories Veterans Explore Jobs Clinical ServicesMedical Case Manager - Delaware Explore our jobs Medical Case Manager - Delaware Apply Open in new tab iconDE Working at Home - DelawareCompany Highmark Inc.Job Description JOB SUMMARYThis is a full-time hybrid work from home and community-based position requiring frequent travel within the assigned territory. A portion of this role involves working directly with members where they are - in-home hospitals PCPs etc.This job assures that members with complex medical andor psychosocial needs have access to high quality cost-effective health care. Assists in the holistic assessment planning arranging coordinating monitoring evaluation of outcomes and activities necessary to facilitate member access to healthcare services. Advocates for the most appropriate care plan using sound clinical judgment accurate planning and collaboration with internal andor external customers and contacts. Follows established regulatory guidelines policies and procedures in relation to member interventions and documentation of activities related to the members care and progress across the continuum of care. Facilitatesandor participatesin interdisciplinary andor interagency meetings when necessary to facilitate coordination of servicesresources for members.ESSENTIAL RESPONSIBILITIESCommunicate effectivelywhile performing customer telephonic interviewing and communication with external contacts.Communicate effectivelywhile interactingwith Case Management Specialists Management Team Physician Advisors and other interdepartmental contacts.Maintain knowledge of Medical Terminology and Medical Diagnostic CategoriesDisease StatesEducate members to enhance member understanding of illnessdisease impact and to positively impact member care plan adherence pharmacy regimen maintenance and health outcomes.Collaborate with Primary Care Physicians Medical Specialists Home Health and other ancillary healthcare providers with the goal being to coordinate member care.Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs.Work primarily independently to identify define and resolve a myriad of problem types experienced by the member.Develop an individualized plan of care designed to meet the specific needs of each member.Anticipate the needs of members by continually assessing and monitoring the members progress toward goals care plan status and re-adjust goals when indicated.Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services.Be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention to develop a realistic plan of care.Communicateand collaboratewith other payers when applicable to create a collaborative approach to care management and benefit coordination.Maintain a working knowledge of available community resources available to assist members.Coordinate with community organizationsagencies for the purpose of identifying additional resources for which the MCO is not responsible.Work within a Team Environment.Attend and participate in required meetings including staff meetings internal Rounds and other in-services to enhance professional knowledge and competency for overall management of members.Participatein departmental andor organizational work and quality initiative teams.Case collaborateswith peers Case Management Specialists Management Team Physician Advisors and other interdepartmental contacts.Participate in interagency andor interdisciplinary team meetings when necessary to facilitate coordination of member care and resources.Foster effective work relationships through conflict resolution and constructive feedback skills.Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure if applicable.Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served to foster constructive and collaborative solutions to meet member needs.Other duties as assigned or requested.QUALIFICATIONSMinimumBachelors degree in nursing or RN certification in lieu of bachelors degree or Masters degree in Social Work Counseling Education or related field and 3 years experience in Acute or Managed Care experience with Medicaid or Medicare populations. ORBachelors degree in Social Work with five years experience in Acute or Managed Care experience with Medicaid or Medicare populationsPreferredExperience working with high-risk pregnant women OR experience working with chronic condition adult populations OR experience with pediatrics3 years of experience in working in Acute CareManaged CareMedicaid and Medicare populations.Bilingual EnglishSpanish language skills.Case Management CertificationLICENSES AND CERTIFICATIONSRequiredLicensed Social Worker LSW-Non-Specific - State OR Licensed Professional Counselor LPC - Non-Specific State OR Licensed Bachelors Social Worker LBSW OR Licensed Clinical Social Worker LCSW - Non-Specific OR Licensed Master Social Worker LMSW Non-Specific OR Licensed Graduate Social Worker LGSW OR Licensed Certified Social Worker LCSW. Incumbents in the role prior to 1125 who are not currently licensed must obtain licensure by 6302026.OR Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact eNLC.PreferredNoneSkillsNoneSCOPE OF RESPONSIBILITYDoes this role supervisemanage other employeesNo WORK ENVIRONMENTIs Travel RequiredNoDisclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties responsibilities and qualifications required of employees to do this job.Compliance Requirement This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.As a component of job responsibilities employees may have access to covered information cardholder data or other confidential customer information that must be protected at all times. In connection with this all employees must comply with both the Health Insurance Portability Accountability Act of 1996 HIPAA as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Companys Handbook of Privacy Policies and Practices and Information Security Policy.Furthermore it is every employees responsibility to comply with the companys Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws rules and regulations as well as company policies and training requirements. Pay Range Minimum57700.00Pay Range Maximum107800.00Base pay is determined by a variety of factors including a candidates qualifications experience and expected contributions as well as internal peer equity market and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal state or local law.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process please contact the email below.For accommodation requests please contact HR Services Online at HRServiceshighmarkhealth.orgCalifornia Consumer Privacy Act Employees Contractors and Applicants Notice Apply Job DetailsJob categoryClinical ServicesPosition TypeFull TimePosted03062026LocationsDE Working at Home - DelawareLine of BusinessEntityRecruiterHiring ManagerExperience LevelJob FamilyCareCase Management-HMReq IDJ277909 Share Facebook X LinkedIn Whatsapp Email Copy URL Apply Open in new tab iconArrow left iconTwitter iconFacebook iconLinkedin iconInstagram iconYoutube iconGlassdoor icon Featured Links Competitively Sensitive Information Cyber Security Notice at Collection E-Verify English E-Verify - Employee Rights and Responsibilities Data Protection Sitemap Terms of Service Do Not SellShare E-Verify Spanish Digital Privacy Policy Highmark Health is an independent licensee of the Blue Cross Blue Shield Association. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal state or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process please contact the email below. For accommodation requests please contact HR Services Online at HRServiceshighmarkhealth.org. © 2026 Highmark Health. All Rights Reserved.