About The Position
As a Case Manager, you will support Idaho Medicaid participants through complex medical case management, patient navigation, and care coordination. The role focuses on developing individualized care plans that promote wellness, improve health outcomes, and reduce reliance on emergency services and inpatient care. The Case Manager engages with members primarily by phone and email, while collaborating closely with healthcare providers, community resources, and interdisciplinary teams. This position supports diverse patient populations and plays a key role in helping members understand and access available benefits, services, and medically necessary care.
Requirements
- Bachelor’s degree in healthcare or a related field and/or equivalent training or experience.
- Current Registered Nurse (RN) or Master Social Worker (LMSW).
- Case Management Certification (CMC) required, or ability to obtain certification within two years of hire.
- Minimum of one (1) year of experience in human services and/or three (3) years of clinical practice experience.
Nice To Haves
- Prior case management (CM), utilization management (UM), or care coordination experience strongly preferred.
- Experience in human services is strongly preferred.
- Positions working on specific contracts may require U.S. Citizenship.
Responsibilities
- Performs assessments and evaluations of potential care management patients in accordance with client contractual obligations and/or state requirements.
- Collaborates with healthcare providers and ancillary service providers to validate appropriate treatment plans and identify patient education opportunities.
- Assessment and education activities may include face-to-face interactions for specific contracts.
- Effectively guides members to appropriate benefit information.
- Provides ongoing education to patients and communicates with healthcare providers to ensure the appropriateness of care.
- Recommends and implements adjustments to care plans as needed.
- Evaluates treatment adherence and reassesses patient commitment to necessary behavioral or lifestyle changes.
- Documents activities in accordance with contractual requirements, including individual member status, medical necessity reviews, and negotiations.
- Escalates issues through appropriate channels while adhering to established hierarchical protocols between clinical and non-clinical staff.
Benefits
- 100% employee-owned company
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
