About this opportunity
MAXIMUS lists this Case Manager, RN/LCSW opportunity in oceanside, California. Review the employer’s description below for duties, qualifications and application requirements.
Job description
The Case Manager provides comprehensive coordination of services for service members and their families. This role coordinates patient care and documentation pathways and serves as a liaison between military and civilian medical and non-medical agencies to support continuity of care. The RN Case Manager conducts assessments, planning, and evaluation of care to promote optimal health and support successful transitions back to duty or into the civilian community.
nCandidates must live in or near Camp Pendleton, CA; Coronado, CA; Cannon AFB, NM; Dam Neck, VA; JEB Little Creek, VA; Fort Benning, GA; Fort Bragg, NC; Fort Campbell, KY; Fort Carson, CO; Joint Base Lewis-McChord, WA; Homestead AFB, FL; Hurlburt Field, FL; Eglin AFB, FL; or MacDill AFB, FL.
nU.S. citizenship is required. Candidates must possess an active U.S. Government Secret security clearance or be eligible to obtain and maintain a Secret security clearance as required for contract performance. This position is pending upon contract award.
nWhy Maximus?
n?? Flexibility That Fits Your Life - Work/life balance support with flexibility designed to meet your personal and professional needs.
n?? Robust Health & Insurance Benefits - Choose from a variety of Medical, Dental, Vision, and
nPrescription plans, plus a partially funded HSA. You'll also have access to Life Insurance and discounts on Auto, Home, Renters, and Pet Insurance.
n?? Build Your Financial Future - Take advantage of our 401(k) Retirement Savings Plan with Company Match to help you plan for what's ahead.
n?? Generous Time Away From Work - Recharge with PTO, paid holidays, extended sick leave, and Short and Long Term Disability coverage.
n?? Wellness Beyond the Workplace - Access resources that support your physical, emotional, and financial well-being through our Employee Assistance Program (EAP).
n?? Recognition That Matters - Celebrate achievements and recognize colleagues through our employee recognition platform.
n?? Invest in Your Growth - Continue your education and professional development with Tuition Reimbursement opportunities.
n?? Employee Discounts & Perks - Enjoy exclusive savings, special offers, and additional employee-only benefits.
n?? Wellness Programs & Resources - Explore a variety of programs and tools designed to support your overall health and wellness.
n?? Career Development Opportunities - Enhance your skills through training programs, workshops, conferences, and ongoing learning opportunities.
n?? Licensure & Certification Support - Maximus covers the costs associated with renewing required licenses and certifications.
nEssential Duties and Responsibilities:
nnnResponsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
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nnRender medical necessity determinations for Medicare State East cases assigned.
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nnResolve all other technical issues within Medicare reconsideration assigned.
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nnReview cases to determine and summarize facts of each case assigned and assess issues involved in the case.
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nnMay perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
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nnBe the Subject Matter Expert (SME) for project.
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nnPerform other duties as assigned by management.
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n n'- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
nnnDemonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
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nnKnowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
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nnKnowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
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nnSkill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
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nnKnowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
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nnKnowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
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nnUse of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
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nnUse of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
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nnUse of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
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n nMinimum Requirements
n'- Bachelor's degree with 5-7 years of experience consulting within designated function.
nnnAdvanced degree preferred.
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nnDevelop solutions to highly complex problems which require a high degree of ingenuity and innovation.
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nnEnsure solutions are consistent with organization objectives.
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nnSolutions may serve as precedent for future decisions.
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nnDevelop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
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nnDevelop new applications based on professional principles and theories.
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nnViewed as expert in field within the organization.
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n n'- Active RN license OR Active Licensed Clinical Social Worker (LCSW) license with a minimum two (2) year nursing degree from an accredited institution.
nnnMinimum of (2) years of nursing and/or case management experience.
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nnCertification as a case manager by a recognized certifying organization, such as the Commission for Case Manager Certification, American Case Management Association, or American Nurses Credentialing Center; or ability to obtain certification within one (1) year of hire.
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nnProfessional oral and written communication skills with peers, outside agencies, vendors, providers, and Military Health System stakeholders.
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nnSkill in team coordination, facilitation, and communication to support information exchange, goal achievement, client support networks, and change in systems or policies.
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n nHome Office Requirements
n-Maximus provides company-issued computer equipment
n-Reliable high-speed internet service
n-Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
n-Minimum 5 Mpbs upload speeds
nMaximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
nMinimum Salary
n$73,950
nMaximum Salary
n$105,850
Worksite address
oceanside, CA, 92058, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.