Medical Case Manager - (Delaware) Maternity - Behavioral Health

Key Responsibilities

The Medical Case Manager assures members with complex medical or psychosocial needs access high-quality, cost-effective healthcare by assessing, planning, coordinating, and monitoring their care continuum. This involves advocating for appropriate care plans, collaborating with providers, and ensuring adherence to regulatory guidelines and documentation standards.

Requirements

Candidates need a Bachelor's degree in nursing or RN certification (or Master's in Social Work/Counseling/Education) plus 3 years of experience in Acute or Managed Care, specifically with Medicaid or Medicare populations, or a Bachelor's in Social Work with five years of relevant experience. Preferred experience includes working with high-risk pregnant women, chronic conditions, or pediatrics, and licensure as a Licensed Social Worker or RN is required.

Qualifications

Education

Master's degree (postgraduate degree)

Experience

2+ years of experience

Key Skills