Care Manager II (RN/SW) - HIDE D-SNP

Position Summary

The Care Manager II (RN/SW) provides remote care management and care coordination for members enrolled in a Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP). This role serves as the primary point of contact for assigned members, supporting complex medical, behavioral health, and social needs through assessment, care planning, member engagement, and coordination of services.

The ideal candidate has experience managing complex Medicare and Medicaid populations, strong clinical judgment, and the ability to build member relationships in a remote environment.

Required Licensure

Current, unrestricted South Carolina license in good standing as one of the following:

- Registered Nurse (RN)
- Licensed Independent Social Worker-Clinical Practice (LISW-CP)
- Licensed Master Social Worker (LMSW)
- Licensed Professional Counselor (LPC)

Education & Experience

Required:

- Associate's degree in Nursing, Master's degree in Social Work, Counseling, or related healthcare field
- Minimum 3 years of clinical, case management, care coordination, or managed care experience
- Experience working with adults with chronic and complex medical conditions
- Strong computer skills, including Microsoft Office and electronic documentation systems

Preferred:

- BSN
- Medicare, Medicaid, D-SNP, HIDE D-SNP, LTSS, or managed care experience
- Remote care management experience
- Knowledge of South Carolina Medicaid programs, waiver services, and community resources
- CCM or other care management certification

Key Responsibilities

- Conduct comprehensive member assessments to identify medical, behavioral, and social needs.
- Develop and maintain individualized, person-centered care plans.
- Coordinate care across providers, behavioral health services, community resources, and support programs.
- Address social determinants of health, including housing, transportation, food security, and caregiver needs.
- Perform medication reconciliation and support medication adherence.
- Provide transitional care management following hospital, emergency department, or skilled nursing facility admissions.
- Engage members through ongoing outreach, education, and health coaching.
- Collaborate with interdisciplinary care teams to improve member outcomes.
- Maintain accurate documentation and comply with CMS, NCQA, Medicare, Medicaid, and organizational requirements.
- Manage an assigned caseload while meeting quality and productivity expectations.

Knowledge, Skills & Abilities

- Knowledge of Medicare, Medicaid, and dual-eligible populations.
- Strong assessment, critical thinking, and care coordination skills.
- Excellent communication and member engagement abilities.
- Experience addressing behavioral health and social determinants of health.
- Ability to manage multiple priorities in a remote work environment.
- Commitment to delivering high-quality, member-centered care.

Work Environment

- Primarily remote position.
- Occasional travel may be required for training, meetings, or business needs.

Ideal Candidate: An experienced RN or Social Worker with Medicare/Medicaid care management experience who thrives in a remote environment and is passionate about improving outcomes for complex, high-risk dual-eligible members.