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Case Manager
Sigma Systems. Manage members with complex health needs across the continuum of case management services .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex health needs through telephonic clinical assessments, developing individualized care plans, and coordinating community resources. Proficient in chronic disease management, member education, and maintaining compliance with regulatory standards.
Highest-signal resume keywords
Registered Nurse (RN) LicenseCase Management ExperienceDisease Management ExperienceTelephonic Case ManagementCertified Case Manager (CCM)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AssessmentCare CoordinationIndividualized Care PlansPreventive Health ServicesChronic Disease ManagementDocumentation SkillsMotivational InterviewingTime ManagementCommunity Resource CoordinationMember Education
Soft Skills
Excellent Communication SkillsCompassionate ApproachStrong Organizational SkillsAbility to Work IndependentlyProfessionalism
Tools & Technologies
Clinical Information System1-800/Member Service Line
Certifications & Qualifications
Registered Nurse (RN)Certified Case Manager (CCM)
Industry Keywords
Managed CareMedicaidHealth PromotionChronic Disease ManagementCase Management Services
About the role
Key responsibilities & impact- Manage members with complex health needs across the continuum of case management services
- Conduct telephonic clinical assessments addressing members’ health and wellness needs
- Support members with chronic and complex conditions through education, coaching, resources, and interventions
- Develop case-specific or condition-specific plans of care using the clinical information system
- Establish short- and long-term health goals
- Maintain regular telephonic contact with members to review progress and reassess needs
- Modify care plans when appropriate
- Communicate with treating providers in complex clinical situations
- Provide education, consultation, and training to other clinical teams
- Identify online, telephonic, and community-based resources and assist members in accessing services
- Educate members about health conditions, self-management, preventive care, lifestyle improvements, and healthcare resources
- Incorporate preventive health services and lifestyle improvement opportunities into member interactions
- Accurately document activities according to business processes, regulatory requirements, and accreditation standards
- Assist with appeals/denials, provider inquiries, claims processing, and benefit information interpretation
- Coordinate specialized services such as transplant facilities and other member support programs
- Perform other duties as assigned
Requirements
What you’ll need- Must hold a current, active Registered Nurse (RN) license in Pennsylvania
- Must reside in Pennsylvania to work remotely
- US Citizenship required
- 5+ years of relevant healthcare/case management experience
- Disease Management experience required
- Strong clinical assessment experience, particularly for care coordination and member education
- Prior Case Management experience
- Experience working in Managed Care environments
- Experience working with Medicaid populations strongly preferred
- Telephonic Case Management / telephonic outreach experience preferred
- Experience developing and managing individualized care plans
- Experience identifying and coordinating community resources
- Knowledge of preventive health services and chronic disease management
- Experience with an 1-800/member service line preferred
- Strong clinical assessment and care coordination skills
- Excellent verbal and written communication skills
- Strong member education and motivational interviewing abilities
- Ability to work independently and effectively manage time and caseloads
- Strong organizational and documentation skills
- Compassionate and professional approach when working with members
- Strong understanding of chronic disease management and health promotion
- Excellent work ethic and ability to operate effectively in a remote environment
- Must complete the Care Manager Assessment
- Certified Case Manager (CCM) certification preferred
Benefits
Comp & perks- Contract duration: 6 months
- Remote work arrangement for candidates residing in Pennsylvania
- ASAP start date