Case Manager Long-term Care - RN; Delaware Kent and Castle

Highmark Inc.

Serves as the single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This full‑time community‑based position requires frequent travel within an assigned territory in DE and involves working directly with members in their homes as well as providing case management services within nursing facilities.

• Conduct regular in‑home and nursing facility visits to complete face‑to‑face needs assessments and follow‑up telephonic contact with members per state and national guidelines.
• Participate in nursing facility care plan conferences and coordinate care across the continuum—including physical, behavioral, chronic health care, and custodial services.
• Authorize LTSS and HCBS services based on comprehensive needs assessments and facilitate care transitions between settings such as hospital to home or nursing facility to community.
• Educate members or caregivers about health care needs, available benefits, resources, and services, including long‑term care options.
• Develop individualized care plans with members or caregivers, identify necessary services, and coordinate referrals to specialty programs (e.g., disease management, behavioral health, complex case management).
• Assist members in creating and updating backup plans for coverage gaps and evaluating the effectiveness of service plans, making revisions as needed.
• Document all case management services and interventions in the electronic health record, adhering to privacy, HIPAA, and quality performance standards.
• Perform other duties as assigned or requested.

• Bachelor’s degree in Social Work, health, human, or education services and 3years of experience in long‑term care or related fields.
• Master’s degree in Social Work, health, human, or education services and 1year of experience in long‑term care or related fields.
• Current State RN or LPN licensure.
• Current multi‑state licensure through the Nurse Licensure Compact and 2years of experience in long‑term care.
• High school degree or equivalent and three years of qualifying case‑management experience with the aged, including behavioral health or disabled populations.

• One year of home clinical or case‑management experience.
• Certified Case Manager (CCM).
• Licensed Bachelors Social Worker (LBSW), Licensed Masters Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW).
• Experience working with HIV/AIDS, behavioral health, or developmental disabilities populations.
• Medicare, Medicaid, and managed‑care experience.

• Flexible work hours to meet member needs.
• Proficiency in PC‑based word processing and database documentation (Word, Excel, Outlook, Internet).
• Reliable transportation for daily travel within the territory.
• Ability to meet regulatory deadlines.
• Dedicated home workspace for business use.
• Experience with electronic documentation systems and budget management.
• Understanding of cultural competency for targeted populations.

Position involves occasional travel (25–50%) and may require lifting up to 50pounds. Work may be performed out of office or at various sites. Lifting: up to 10pounds constantly; 10–25pounds occasionally; 25–50pounds rarely.

Works from Home with occasional in‑office visits.

Minimum: $72,700.00 — Maximum: $ (base pay determined by qualifications, experience, and contributions).

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on veteran status, disability, and all protected categories under applicable federal, state, and local law. The organization is committed to accessibility for all users and to accommodate applicants with disabilities.