Remote Healthcare Case Manager

Job Summary

Supporting the Enhanced Care Advocate and ECM team, the full-time Remote Healthcare Case Manager will manage vendor, carrier, and CMS communications, develop care plans for members with diverse health scenarios, and coordinate case evaluations and referrals remotely.

Key responsibilities

• Review clinical data and develop strategic care plans connecting members to specialized vendor partners
• Coordinate with members, clients, and Allied staff to implement care plans and troubleshoot escalated issues
• Document casework impacts to highlight cost savings and improvements in member health outcomes

Required qualifications

• Bachelor's degree or equivalent work experience required
• 2 years of experience with Group Health Insurance and Self-Funded Health Plans required
• Experience in Medicare, Medicaid, Case Management, and prescription drug benefits preferred
• Proficient with Microsoft Office Suite or related software
• Life and Health Insurance Producers License is preferred, but not required