Claims-CW - Care Manager, RN – CW

SGS_JOB_1307

Business Support
 Delaware
(Care Manager or Case Manager and Registered Nurse or RN and Diseases Management or Chronic Diseases)

Contract - 3 months Contract to hire

• Contract to hire opportunity. Manager starts to look at candidates at the 3 month mark to see if they are a fit and starts considering hiring. Will extend out 3 months at a time until hired full time. • Please include candidate's conversion salary (range between ($50,200-$90,300) Position is for Kent County (candidates must be located within that county) • Must reside in Delaware Face-to-face visits will be required. • Must be willing to begin visits on week 1. • The resource will mostly, with few exceptions, be going into homes to visit home-based members (occasionally to motels, if the member is unhoused, or to hospitals, but these will be sporadic visits) • Candidate MUST complete the Care Manager assessment in Glider. Include the completed link in the candidate's submit form*** • There will be three weeks of training for this role. During the training, the candidate will be expected to utilize basic computer skills involving emails, Outlook, etc

Job Responsibilities:

  • Travel to members’ homes (occasionally a hospital or motel and very rarely a long-term care facility or nursing home) and other community based settings in order to complete face to face needs assessments with subsequent telephonic contact with the member in accordance with state and national guidelines, policies, procedures, and protocols.
  • Assess, plan, coordinate, implement and evaluate care for eligible members with chronic and complex health care, social service and custodial needs in a nursing facility or home and community-based care setting.
  • Coordinate care across the continuum of services and assisting members physical, behavioral, long term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive way possible while considering the most cost-effective way to address those needs.
  • Facilitate authorization, coordination, continuity and appropriateness of care and services in community or HCBS.
  • Facilitate transitions to alternate care settings such as hospital to home, nursing facility to community setting using an integrated care team to address the member’s specific needs.
  • Educate members or caregivers regarding health care needs, available benefits, resources and services including available options for long term care community or facility-based service delivery.
  • Provide education, resources, and assistance to help members achieve goals as outlined in their plan of care and to overcome obstacles to achieving optimal care in the least restrictive environment.
  • Develop a plan of care in conjunction with members or caregivers to identify services to meet the member’s specific needs, and goals.
  • Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
  • Collaborate with the member's health care and service delivery team including the DSHP Plus LTSS Member Advocate, ICT, and discharge planners, to coordinate the care needs and community resources for the member in order to maintain the member in the least restrictive safe environment possible. Assist members in developing, implementing and amending a back-up plan for gaps in provider coverage.
  • Ensure approved support services are being provided as outlined in the plan of care. Evaluate the effectiveness of the service plan and making appropriate revisions as needed in accordance with per policy & procedures and state contractual requirements.
  • Assist members in overcoming obstacles to optimal care through connection with community resources, including communicating with providers and formulating an appropriate action plan.
  • Document all case management services and intervention in the electronic health record. Adhere to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.
  • Perform other duties as assigned/requested.

Skills:

  • Registered Nurse in the state of DE, with case management experience
  • Experience completing Assessments, developing Service Plans and Care Plans
  • Experience collaborating with PCP’s, Occupational Therapists, Behavioral Health, and Providers
  • Experience with ordering DME Equipment
  • Experience educating and providing resources for the member’s Social Determinants. They must have experience with discharging members from a Facility setting.
  • Working flexible hours to meet member’s needs
  • Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)
  • Reliable transportation daily to be able to travel within assigned territory
  • Ability to meet regulatory deadlines.
  • Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies.
  • Experience in geriatric special needs, behavioral health, home health
  • Understanding of the importance of cultural competency in addressing targeted populations.
  • Experience with electronic documentation systems
  • Experience with cost neutrality and budgeting
  • Must be willing to travel throughout the state (may only need to travel 2-3 times a week depending on schedule)
  • Must be able to communicate clearly to members - will be tasked with conducting assessments with members over the phone
  • Must be very organized

Education/Experience:

  • Certified Case Manager (CCM)
  • Licensed Bachelor’s Social Worker (LBSW)
  • Licensed Master’s Social Worker (LMSW)
  • Licensed Clinical Social Worker (LCSW)
  • Experience working with HIV/AIDS population
  • Experience working with behavioral health population
  • Experience working with developmental disabilities population
  • Medicare and Medicaid experience

Related Jobs

Service Desk Agent

Business Support
 Texas
06+ (temp to hire)

This position is responsible for providing technical and operational support to Health’s Clinician Network (Providers) and employee groups. Our clinician network includes healthcare professionals (Nurse Practitioners, Doctors, etc.) who provide home healthcare services. 

Windows OS devices
Dell Peripherals
Logitech
mobile device management tools

Business Systems Analyst I

Business Support
Remote
06 Months (Possibilities of Contract Extension)

This role exists as a member of the Client's Enterprise CLM Solutions team, primarily aligned with the Run State Maintenance sub team. The Business Systems Analyst I will support business owners in identifying specific business problems and the associated Icertis system needs and services.

Analytical skills
Project management
Interpersonal skills
Functional specifications writing
Customer service
Organizational skills
MS-Excel
Word
PowerPoint
Syntex
SaaS applications
Agile methodology
Jira
Contract Lifecycle Management
Icertis Platform configuration

Quality Control Analyst I

Business Support
 Florida
03-04+ Extendable Contract

This position performs testing of raw materials and drug products, maintenance and calibration of analytical instruments, prepares standard and sample solutions and maintains appropriate records.

Wet Chemistry testing
LOD
PH
API

Warehouse Devices Deployment Technician

Business Support
 Texas
06+ (Contract to Hire)

We are seeking a skilled Warehouse Devices Deployment Technician contractor to join our team for the rollout and upgrade of devices throughout warehouses and plants. The ideal candidate will have a minimum of 5 years’ experience in configuring, installing, maintaining and repairing warehouse equipment, including handheld devices, tablets, printers and voice picking devices.

MDM tools
Intune
SOTI

HR Employee Relations Professional

Business Support
 Arizona
12 Months (Possibilities of Contract Extension)

As an Employee Relations (ER) Specialist at Client, you will uphold our Vision, Values, and Commitments (VV&Cs) while maintaining a fair and respectful work environment. You will manage ER activities, conduct investigations, resolve employee concerns, and provide guidance on ER matters.

Employee Relations
Investigations
Employment Law
Conflict Resolution
Data Analysis

Project Controls Planner

Business Support
 Texas
12 Months (Possibilities of Contract Extension)

This position involves schedule development, maintenance, monitoring, and recovery plan development for Proposal, FEED, or EPC project schedules for the Corpus Christi Liquefaction Stage 3 Program. The role supports project organizational and administrative activities and requires significant in-person attendance.

Planning and scheduling
EPC projects
Primavera
Microsoft Office
engineering and procurement processes

Business Analyst – Oracle

Business Support
 Arizona
12 Months (Possibilities of Contract Extension)

In this role, you will participate in the programming and configuration of an Enterprise Resource Planning (ERP) application that is integrated with business processes/data and IT infrastructure. You will assist with development of workflow and data conversion, and with software integration and external interfaces. Your work will contribute to supporting business needs with technological solutions.

PL/SQL
Oracle eBusiness applications
Techno Functional experience
Oracle ‘Procure to Pay’ process
CEMLI
SQL
Performance Tuning
Oracle Workflow
AME
XML Publisher
WebADI

System Analyst – Oracle

Business Support
 Arizona
12 Months (Possibilities of Contract Extension)

In this role, you will participate in the programming and configuration of an Enterprise Resource Planning (ERP) application that is integrated with business processes/data and IT infrastructure. You will assist with development of workflow and data conversion, and with software integration and external interfaces. Your work will contribute to supporting business needs with technological solutions

PL/SQL
Oracle eBusiness applications
Techno Functional experience
Oracle ‘Procure to Pay’ process
CEMLI
SQL
Performance Tuning
Oracle Workflow
AME
XML Publisher
WebADI

Marketing Manager II (Retail/ Supply Chain)

Business Support
 Texas
04 Contract (LOA)

Manages the promotion and direction of the Marketing Activities, improvement of Company's Product Image, Market Data, And Information. Identifies and evaluates marketing strategies, based on knowledge of organization objectives, market characteristics, cost and markup factors. Determines the demand for products and services offered by an organization and its competitors. Manages and coordinates activities of the marketing staff, including hiring, tra Digital Marketing Project Manager

Microsoft Office
Outlook
MDStaff
Word
Excel
logo

At SGS Consulting, we go beyond resume-job matches, creating meaningful connections and pathways for individuals to thrive in defining careers.

Our Services

Contingent Workforce Solutions

Strategic SOW Services

Payroll Solutions


2025. All right reserved.
logologologologo