Case Manager Long-term Care; Remote

Job Summary

Highmark Inc. is looking for a Community Case Manager to serve as the single point of contact for members, coordinating care across services and community supports. This full‑time position requires frequent travel within the assigned territory in DE and involves direct member contact in homes and nursing facility settings.

• Conduct regular in‑home and nursing facility visits, performing face‑to‑face needs assessments and following up telephonically in accordance with state and national policies and protocols.
• Participate in nursing facility care‑plan conferences and ensure member needs are met.
• Assess, plan, coordinate, implement, and evaluate care for eligible members with chronic and complex health, social service and custodial needs in nursing or home/community settings.
• Coordinate care across the continuum of services and assist members with physical, behavioral, long‑term services and supports (LTSS), social, and psychosocial needs while considering cost‑effectiveness and least‑restrictive options.
• Authorize LTSS services after completing a comprehensive needs assessment.
• Coordinate HCBS services, Medicaid and DSNP benefits and assess appropriateness of care and services in the community.
• Facilitate transitions to alternate care settings (e.g., hospital to home, nursing facility to community) using an integrated care team.
• Educate members or caregivers on health care needs, benefits, resources and options for long‑term care.
• Provide education, resources and assistance to help members achieve goals outlined in their plan of care and overcome obstacles to optimal care.
• Develop individualized care plans with members or caregivers to identify services that meet specific needs and goals.
• Identify resources needed for an integrated care coordination approach, including facilitating referrals to special programs such as disease/chronic condition management, behavioral health and complex case management.
• Collaborate with the member’s health‑care and service‑delivery team to coordinate care needs and community resources.
• Assist members in developing, implementing and amending a backup plan for gaps in provider coverage.
• Ensure approved support services are being provided as outlined in the plan of care.
• Evaluate effectiveness of the service plan and make appropriate revisions in accordance with policy and state contractual requirements.
• Assist members in overcoming obstacles to optimal care through connection with community resources and formulating an action plan.
• Document all case management services and interventions in the electronic health record.
• Adhere to all company, state and federal requirements related to privacy practices, HIPAA and quality performance standards.
• Perform other duties as assigned or requested.

• Bachelor’s degree in Social Work or health, human, or education services with 3 years of experience in long‑term care, home health, hospice, public health, or assisted living.
• Master’s degree in Social Work or health, human, or education services with 1 year of experience in long‑term care, home health, hospice, public health, or assisted living.
• Current State RN or LPN licensure.
• Current multi‑state licensure through the Nurse Licensure Compact (eNLC) with 2 years of experience in long‑term care, home health, hospice, public health, or assisted living.
• High school diploma or equivalent with three years of qualifying experience in case management of the aged, including management of behavioral health conditions, or persons with physical or developmental disabilities, or HIV/AIDS populations.
• Preferred:
  One year in home clinical or case management experience.
• Preferred certifications:
  Certified Case Manager (CCM), Licensed Bachelor Social Worker (LBSW), Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW).
• Experience working with HIV/AIDS, behavioral health, developmental disabilities populations, Medicare and Medicaid, and managed care.

• Flexible hours to meet member needs.
• Proficiency in PC‑based word processing and database documentation (Word, Excel, Internet, Outlook).
• Reliable transportation for daily travel within…