Case Manager (LCSW)

About the role

This remote position is open to residents of AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY. U.S. citizenship and a favorably adjudicated Department of Defense background investigation are required. Veterans, Reservists, Guardsmen and military family members are encouraged to apply.

Responsibilities

• Screen referrals for case management and perform comprehensive assessments.
• Develop and implement individualized care plans; monitor for effectiveness and outcomes.
• Conduct reassessments as needed to ensure identified needs are addressed.
• Review and process authorization and referral requests according to policy.
• Ensure compliance with HIPAA privacy and security regulations and URAC accreditation standards.
• Identify beneficiaries at high risk for adverse health outcomes and with high-cost clinical and psychological factors.
• Document case management enrollment information and acceptance letters; notify beneficiaries in a timely manner.
• Complete comprehensive case management assessments and develop individualized care plans to help beneficiaries obtain quality, cost-effective care.
• Obtain necessary agreements for protected health information; make care plans available to Primary Care Managers or Behavioral Health providers.
• Reassess and adjust care plans at least monthly; document changes in the medical management system.
• Evaluate case management outcomes, including beneficiary satisfaction and compliance with the care plan.
• Prepare and present high-profile or sensitive cases to the Medical Director for review.
• Advocate for beneficiaries by ensuring access to necessary care, maintaining safety, identifying specialized services, and facilitating provider access.
• Provide TRICARE and community resource information and internal care referrals to meet care plan goals.
• Administer TRICARE Specialty Program benefits, including registration, enrollment, authorizations, and screening for catastrophic case management eligibility.
• Monitor and provide direction to non-clinical staff.

Education & Experience

• Current unrestricted state license as a Licensed Clinical Social Worker.
• Two years full-time equivalent of direct clinical care to the consumer.
• Ability to obtain a URAC-recognized certification in case management within four years of hire.
• Must be able to receive favorable Interim and adjudicated final Department of Defense background investigation.
• U.S. Citizenship required.
• Preferred: 2 years case management experience and URAC-recognized case manager certification.

Competencies

• Communication / People Skills: Influence and persuade diverse stakeholders; adapt communication styles; actively listen; foster collaboration.
• Computer Literacy: Proficiency in Microsoft applications (Word, Outlook) and department-specific software within a multi-system environment.
• Coping / Flexibility: Navigate diverse situations; maintain purpose; employ mature problem-solving and adaptability.
• Empathy / Customer Service: Customer-centric approach with patience, respect, attentive listening, and empathy.
• Independent Thinking / Self-Initiative: Resourceful critical thinker who prioritizes tasks, secures resources, and proactively achieves outcomes.
• Multi-Tasking / Time Management: Prioritize and manage tasks to meet evolving deadlines in a high-volume, fast-paced environment.
• Organizational Skills: Coordinate people and tasks; adjust to changing priorities; master systems efficiently under time constraints.
• Problem Solving / Analysis: Systematic process analysis guided by sound judgment and practical understanding of pertinent issues.
• Team-Building / Team Player: Influence actions and opinions positively; build group engagement.
• Technical Skills: Knowledge of case management, utilization management, TRICARE policies and procedures, HIPAA, URAC standards, managed care, behavioral health, Medicaid/Medicare, community resources, funding programs, and medical management systems; proficiency with InterQual ISD® criteria and medical coding.

Working Conditions

• Availability to cover any work shift.
• Standard office environment with minimal travel; extensive computer work with long periods of sitting.
• Department of Defense security clearance required.

Benefits

• Medical, dental and vision coverage.
• Paid time off.
• 401(k) retirement savings plan with matching.
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance.
• Tuition reimbursement.
• Paid volunteer time.
• Frequent pay raises, overtime opportunities, recognition and reward programs.

Pay

Salary range: approximately $77,000 – $90,000 per year.