Field Case Manager

SGS_JOB_2721

Business Support
 Florida
Case Management
Case Manager
Case Manager
Long Term Care
Prior Authorization

Contract - 03+ Months Extendable

o Location (mandatory): Candidate must be in Hillsborough County. Preferably in the following zip codes: 33602,33603, 33604, 33605, 33606, 33607, 33609, 33610, 33612, 33614, 33617 Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and complex members. Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Case Management Coordinators will determine appropriate services and support due to member’s health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports. Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.

Job Responsibilities:

  • Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollers.
  • Utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
  • Conducts comprehensive evaluation of Members using care management tools and information/data review
  • Coordinates and implements assigned care plan activities and monitors care plan progress
  • Conducts multidisciplinary review to achieve optimal outcomes
  • Identifies and escalates quality of care issues through established channels
  • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
  • Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
  • Provides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choices
  • Helps members actively and knowledgeably participate with their provider in healthcare decision-making
  • Monitoring, Evaluation and Documentation of Care:
  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Skills:

  • One year Case management experience A MUST / Case Management Certificate ( Preferred)
  •  Training will be conducted remotely via Microsoft Teams.
  • Candidate will travel approximately 75% of the time within the region seeing
  • Members at home, in assisted living facilities and nursing homes.
  • Preferred Qualifications: Bilingual Spanish/English (preferred)

Education/Experience:

  • Bachelor's degree required - No nurses. Social work degree or related field preferred.

Related Jobs

USA – Quality Control Chemist – IV

Business Support
 Washington
12 Months Contract

Location (mandatory): Bothell, WA, USA 98021 Small Description: The Method Transfer Lead (MTL), Scientist, is a Quality Control expert within the QCSV group responsible for ensuring analytical method transfer and/or validation activities comply with cGMP and regulatory expectations. This role serves as an individual contributor with a strong understanding of analytical method transfer, validation strategies, and regulatory requirements. The position supports internal and external method transfer activities while collaborating with global QC labs and cross-functional teams. The scientist authors and reviews technical documentation, analyzes complex data, and represents QC on project teams. The role requires strong scientific judgment, project management skills, and effective communication to support program and company goals.

Method Transfer
Method Validation
cGMP
Analytical Chemistry
QC
Data Analysis
Technical Writing
Regulatory Compliance

Estimator III

Business Support
 Washington
12 Months

Location : Richland, WA 99352 Small Description: The Estimator III (Principal) is a senior-level estimating professional responsible for developing, reviewing, and communicating comprehensive project and program cost estimates in support of project management at the Columbia Generating Station (CGS). This role partners with engineering, planning, procurement, and construction teams to deliver accurate estimates across all phases of project development while continuously improving estimating and scope management processes in a highly regulated industrial and nuclear environment.

Estimate
Contract.

Customer Support Analyst

Business Support
 Texas
12 Months

Location : Houston Texas Small Description: The Customer Support Analyst is responsible for supporting customers through accurate data entry, utility outreach, and timely resolution of billing and payment-related inquiries. This role requires strong attention to detail, analytical thinking, and a customer-focused mindset to ensure customers are onboarded efficiently while meeting established performance metrics in a fast-paced, remote work environment.

Customer Service
Data Entry
Excel.

Construction Manager

Business Support
 Pennsylvania
12 Months

Location : Berwyn PA Small Description: Experienced Construction Manager / Construction Supervisor needed to support major transmission and substation projects at the Byron, IL site. This role involves overseeing the construction of an electric switchyard within a substation environment, providing field supervision, and ensuring safe, efficient execution of EPC construction activities. The ideal candidate has strong commercial construction experience, hands-on knowledge of electric equipment installation, and experience with transmission and distribution systems. Prior experience at the Byron station and familiarity with nuclear environments is preferred.

Construction
Transmission.

Senior Professional Application Designer

Business Support
Remote
3+ Months Contract (Contract-to-Hire based on performance)

Description: As a Batch Developer, this role involves design, development, testing, and support activities across the full software development lifecycle. The Senior Professional Application Designer will investigate and resolve complex business and technical integration issues and focus on specific products or technology platforms. The role functions independently within a business area and contributes at the enterprise level by influencing technical decisions throughout project phases. The team requires an experienced Application Designer with strong batch processing and healthcare domain expertise to support enterprise-level Medicaid Claims systems. This position is intended as a long-term opportunity with potential conversion to full-time employment based on performance.

Design
develop
test
debug
implement

Supply Chain Analyst II

Business Support
 North Carolina
6 months

Location : Remote (onsite training in Charlotte, NC 28217) The Supply Planner is responsible for balancing supply and demand to ensure product availability while controlling inventory and supporting operational efficiency. This role partners closely with demand planning, procurement, manufacturing, and logistics teams to create and maintain supply plans that meet business goals.

Demand planning
procurement
manufacturing
ERP systems
SAP or Oracle

Insurance Verification Specialist or Case Management Assistant

Business Support
Remote
3 months

Seeking professionals with experience in health insurance or Medicaid verification to support Medicaid-eligible members under the HIPP / Premium Assistance Program. The role involves insurance verification, eligibility documentation, case maintenance, and high-volume customer interaction.

Insurance verification
health insurance
Medicaid verification
Customer service
and HIPP / Premium Assistance Program

Senior Professional Application Designer

Business Support
Remote
6+ Months

Designs, develops, installs, tests, and documents complex application software including server, client, and web-based components. Contributes to the design and delivery of technical architecture solution components and provides technical guidance to less experienced personnel. May provide technical consulting support on complex initiatives while ensuring adherence to industry and organizational standards. Background/Need: Team requires an experienced Application Designer to support enterprise-level application design and development efforts. This role supports complex system initiatives, ensures high-quality application architecture, and improves development efficiency while working in a fully remote, fast-paced environment during EST hours.

SQL
Linux commands
IWS
Software Development Life Cycle (SDLC)

Health Insurance Verification / Insurance Verification Specialist

Business Support
 Georgia
3 months

Location : Tucker, GA 30084 (Remote) Seeking professionals with experience in health insurance or Medicaid verification to support Medicaid-eligible members under the HIPP / Premium Assistance Program. The role involves insurance verification, eligibility documentation, case maintenance, and high-volume customer interaction

Insurance Verification
Health Insurance
logo

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


2025. All right reserved.
logologologologo