Case Manager (CCM)
About The Position
Oscar is hiring a Case Manager for its Complex Case Management team. The Case Manager collaborates across Oscar teams to deliver high-quality care and improve member health outcomes. The role includes educating members, evaluating Social Determinants of Health (SDOH), connecting members with community resources, and contributing to process improvement initiatives and new pilot programs as required. This is a remote position for candidates residing in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia. Daily work is completed from a home office, with occasional travel potentially required for team meetings and company events. The position reports to the Manager, Clinical Programs.
Requirements
- At least 2 years of clinical experience, including hospital, outpatient, or community-based care management.
- At least 2 years of experience working directly with patients with chronic medical conditions, such as diabetes, COPD, or hypertension, with understanding of disease trajectories, common treatment regimens, and symptom management.
- At least 1 year of experience in care coordination and navigation.
- Active, unrestricted U.S. RN licensure in the applicable state, or an active compact multistate unrestricted RN license, or a Master of Social Work (MSW) from a graduate of a Nationally Accredited School approved by the Council on Social Work Education.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- Licensed Master Social Worker or Licensed Clinical Social Worker.
- CCM certification.
- Case management experience.
- Complex Case Management certification.
- Bilingual Spanish skills.
Responsibilities
- Coordinate care across inpatient, outpatient, emergency room, or home care settings while maintaining strict confidentiality and high professional standards.
- Partner with members and providers to navigate complex health challenges and create personalized care plans that improve clinical outcomes.
- Assess and address Social Determinants of Health by connecting members with tailored community support resources.
- Provide crisis intervention support and advocate for members to resolve barriers to care and treatment compliance.
- Engage with members by phone, secure messaging, or in person to educate them about health conditions, hospital discharges, medical procedures, and new prescriptions.
- Comply with all applicable laws and regulations.
- Perform other responsibilities as assigned.
Benefits
- Monthly vacation accrual at a rate of 15 days per year.
- Medical, dental, and vision benefits for full-time employees.
- 11 paid holidays.
- Paid sick time.
- Paid parental leave.
- 401(k) plan participation.
- Life and disability insurance.
- Paid wellness time and reimbursements.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
