Case Manager Long-term Care - Delaware, New Castle County RN

Highmark Health•DE, Working at Home - Delaware, DE

13d•$72,700 - $116,600•Remote

About The Position

This community-based Registered Nurse Case Manager position serves DSHP Plus LTSS and DSNP members in New Castle County, Delaware. The role provides comprehensive case management through frequent travel within an assigned territory for home or site visits, along with ongoing phone support. The case manager assesses member needs, develops and implements care plans, evaluates benefits, coordinates services, and monitors progress. The position focuses on ensuring quality, cost-effective care and preventing improper utilization of member benefits. The case manager manages a moderately complex caseload and coordinates services addressing members’ physical, behavioral, custodial, social, and psychosocial needs. The role includes advocating for members and caregivers, supporting transitions across care settings, evaluating outcomes, identifying cost and quality improvements, and maintaining compliance with company processes, policies, regulatory requirements, and accreditation standards. The position works from home and requires a physical work site when needed, with 25%–50% travel.

Requirements

Current State RN or LPN licensure, or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC), and 2 years of experience in long-term care, home health, hospice, public health, or assisted living; OR
A bachelor’s degree in Social Work or in health, human, or education services and 3 years of experience in long-term care, home health, hospice, public health, or assisted living; OR
A master’s degree in Social Work or in health, human, or education services and 1 year of experience in long-term care, home health, hospice, public health, or assisted living.
Strong assessment and care planning skills.
Ability to work independently and as part of a team.
Proficiency with Microsoft suite applications, case management software, and electronic health records.
Time management abilities.
Understanding of healthcare systems and case management principles.
Travel requirement of 25%–50%.
Ability to meet the listed physical demands: lifting up to 10 pounds constantly, 10–25 pounds occasionally, and 25–50 pounds rarely.

Nice To Haves

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

Responsibilities

Conduct thorough assessments of members’ health status, needs, and resources through in-person visits and ongoing phone support; manage a moderately complex caseload.
Develop, implement, and monitor individualized care plans addressing physical, behavioral, custodial, social, and psychosocial needs, with minimal guidance.
Coordinate access to appropriate services, community resources, and specialists to support efficient and cost-effective service delivery across care settings.
Advocate for members and guide members and caregivers through healthcare decisions and barriers to care plan goals.
Coordinate appropriate and seamless transitions between hospitals, community settings, and facilities.
Monitor member progress, evaluate service effectiveness, and adjust care plans to optimize outcomes.
Identify opportunities for cost savings, quality improvement, and workflow efficiencies in care delivery.
Ensure documentation and activities comply with business processes, company policies, regulatory requirements, and accreditation standards.
Coordinate member benefits across payor sources and work to prevent improper benefit utilization.
Perform other duties as assigned or requested.