REMOTE Case Manager

Remote Care Manager (Medicaid / SDOH)

Location: Remote (Must reside in the Tri-State Area; preference for New York City or NY State)

Schedule: Monday – Friday, 9:00 AM – 5:30 PM EST (Full-Time, 40 hours/week)

Position Type: Full-Time

Job Summary

We are seeking a patient-centered, empathetic, and highly organized Remote Care Manager to join our team. In this role, you will engage health plan members telephonically to assess health-related social needs, coordinate vital community referrals, navigate care services, track member outcomes, and ensure the successful completion of care plans.

The ideal candidate has proven experience supporting Medicaid populations, a deep understanding of the Social Determinants of Health (SDOH), and the technical aptitude to navigate multiple systems seamlessly in a remote work environment.

Key Responsibilities

Member Screening & Needs Assessment

• Conduct outbound telephonic outreach to members to assess social determinants of health, including housing instability, food insecurity, transportation barriers, and healthcare access.
• Complete comprehensive social needs assessments, prioritize members based on acuity/risk factors, and identify care gaps or unmet community resource needs.
• Build trust and rapport with members and caregivers to understand their unique circumstances, goals, and barriers to health.

Care Coordination & Follow-Up

• Develop and execute individualized care plans based on member assessments and personal goals.
• Coordinate targeted referrals to community-based organizations, healthcare providers, and social service agencies.
• Conduct proactive follow-ups via phone, text, or digital platforms to ensure member connection to recommended services.
• Identify and overcome barriers to care, including financial constraints, transportation, language, or system navigation challenges.

Referral Management

• Manage, track, and monitor referrals through established workflows to ensure service delivery and completion.
• Follow up with community partners, providers, and service organizations to verify member engagement and outcomes.
• Escalate unresolved referrals or service delays per established organizational protocols.

Member Engagement & Education

• Educate members and caregivers on navigating healthcare systems, social service programs, and available community supports.
• Utilize motivational interviewing and culturally competent communication to encourage self-advocacy and care plan adherence.

Documentation & Data Management

• Maintain accurate, timely documentation of all member interactions, assessments, referrals, and outcomes within the Electronic Health Record (EHR) / care management platform.
• Ensure strict compliance with HIPAA, organizational policies, and regulatory mandates.
• Track key performance indicators (KPIs), including referral completion rates, care gap closures, and engagement metrics.

Collaboration & Quality Improvement

• Collaborate with interdisciplinary teams (nurses, social workers, care managers, providers, and community partners).
• Participate in regular case reviews, team meetings, and quality improvement initiatives to optimize workflows and care coordination effectiveness.

Required Qualifications & Skills

• Location: Must currently reside in the Tri-State Area (Strong preference for New York State or NYC residents).
• Medicaid Experience: Demonstrated experience working with Medicaid populations and addressing Social Determinants of Health (SDOH).
• Care Management: Proven background in care management, care coordination, or social services.
• Tech-Savvy: High comfort level navigating multiple software platforms, databases, and electronic health records (EHR). Ability to multitask across applications efficiently.
• Dedicated Remote Workspace: Must have a quiet,…