Job Title: Case Manager
Remote
General Description
The Case Manager supports patients with complex, high-risk, or chronic health conditions through coordinated, patient-centered care. This role serves as a liaison between patients, providers, insurance partners, and community resources to ensure continuity of care, reduce barriers, and improve health outcomes. The Case Manager plays a critical role in care coordination, quality initiatives, and patient advocacy.
Essential Duties and Responsibilities
- Manage a caseload of high-risk and high-cost patients with complex medical and social needs
- Identify gaps in care, barriers to treatment adherence, and social determinants impacting health
- Conduct outreach and pre-visit planning to support care coordination and follow-up
- Collaborate with providers, care team members, and insurance partners to ensure continuity of care
- Upload required documentation into insurance portals to meet quality and compliance standards
- Create and analyze reports to monitor high-risk populations and care outcomes
- Coordinate referrals, authorizations, and access to community resources and support services
- Assist with clerical tasks including obtaining medical records, lab results, and consultation notes
- Participate in quality improvement initiatives and required meetings
- Maintain accurate documentation in the Electronic Health Record (EHR)
- Ensure confidentiality and HIPAA compliance at all times
- Represent the organization’s mission, values, and commitment to patient-centered care
- Perform other duties as assigned
Knowledge, Skills, and Abilities
- Basic understanding of medical terminology and healthcare documentation
- Strong organizational, analytical, and problem-solving skills
- Excellent communication skills, both verbal and written
- Ability to work effectively with diverse populations and interdisciplinary teams
- Demonstrates empathy, professionalism, and ethical conduct
- Strong customer service orientation with a patient-first mindset
Qualifications
- Licensed Practical Nurse (LPN) or Associate degree in nursing, social work, or a related field (required)
- Minimum of five (5) years of nursing or healthcare experience
- At least one (1) year of case management or related experience preferred
- Experience with HEDIS, quality metrics, or care coordination preferred
- Current Basic Life Support (BLS) certification preferred
- Ability to obtain and maintain EHR (e.g., Epic) certification and required compliance training
Working Conditions & Physical Requirements
- Ability to sit for extended periods of time
- Ability to lift up to 20 lbs. regularly and 30–50 lbs. occasionally
- Regular exposure to computer screens
- Possible exposure to infectious or contagious diseases