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Job description
Position Summary
nThe Care Manager II (RN/SW) provides remote care management and care coordination for members enrolled in a Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP). This role serves as the primary point of contact for assigned members, supporting complex medical, behavioral health, and social needs through assessment, care planning, member engagement, and coordination of services.
nThe ideal candidate has experience managing complex Medicare and Medicaid populations, strong clinical judgment, and the ability to build member relationships in a remote environment.
nRequired Licensure
nCurrent, unrestricted South Carolina license in good standing as one of the following:
nnnRegistered Nurse (RN)
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nnLicensed Independent Social Worker-Clinical Practice (LISW-CP)
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nnLicensed Master Social Worker (LMSW)
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nnLicensed Professional Counselor (LPC)
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n nEducation & Experience
nRequired:
nnnAssociate's degree in Nursing, Master's degree in Social Work, Counseling, or related healthcare field
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nnMinimum 3 years of clinical, case management, care coordination, or managed care experience
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nnExperience working with adults with chronic and complex medical conditions
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nnStrong computer skills, including Microsoft Office and electronic documentation systems
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n nPreferred:
nnnBSN
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nnMedicare, Medicaid, D-SNP, HIDE D-SNP, LTSS, or managed care experience
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nnRemote care management experience
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nnKnowledge of South Carolina Medicaid programs, waiver services, and community resources
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nnCCM or other care management certification
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n nKey Responsibilities
nnnConduct comprehensive member assessments to identify medical, behavioral, and social needs.
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nnDevelop and maintain individualized, person-centered care plans.
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nnCoordinate care across providers, behavioral health services, community resources, and support programs.
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nnAddress social determinants of health, including housing, transportation, food security, and caregiver needs.
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nnPerform medication reconciliation and support medication adherence.
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nnProvide transitional care management following hospital, emergency department, or skilled nursing facility admissions.
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nnEngage members through ongoing outreach, education, and health coaching.
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nnCollaborate with interdisciplinary care teams to improve member outcomes.
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nnMaintain accurate documentation and comply with CMS, NCQA, Medicare, Medicaid, and organizational requirements.
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nnManage an assigned caseload while meeting quality and productivity expectations.
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n nKnowledge, Skills & Abilities
nnnKnowledge of Medicare, Medicaid, and dual-eligible populations.
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nnStrong assessment, critical thinking, and care coordination skills.
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nnExcellent communication and member engagement abilities.
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nnExperience addressing behavioral health and social determinants of health.
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nnAbility to manage multiple priorities in a remote work environment.
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nnCommitment to delivering high-quality, member-centered care.
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n nWork Environment
nnnPrimarily remote position.
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nnOccasional travel may be required for training, meetings, or business needs.
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n nIdeal Candidate: An experienced RN or Social Worker with Medicare/Medicaid care management experience who thrives in a remote environment and is passionate about improving outcomes for complex, high-risk dual-eligible members.
nAs a company, we support internal diversity through:
nRecruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
Worksite address
columbia, SC, 29228, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.