Remote Case Manager

Job Title: Remote Case Manager

Job ID: 7968-1

Location: Pittsburgh, PA (Remote work - must be located in PA; prefer local to Pittsburgh, but can be located anywhere in the state)

Contract Duration: 6+ Months

Position Type: Contract

Sigma Systems Inc is currently seeking a Remote Case Manager to join our client's team in Pittsburgh, PA. This is an exciting opportunity for a dedicated healthcare professional with a passion for pediatric care and case management. If you are a compassionate, self-driven individual looking to make a difference in the lives of children and families, we would love to hear from you!

Due to the governmental nature of these positions, only US citizens are eligible to apply.

Job Overview

The Pediatric Shift Care Case Manager will play a pivotal role in supporting pediatric members and their families who are receiving in-home nursing and aide care (Shift Care services). This role serves as the main point of contact within Highmark Wholecare, where you will be responsible for case management, needs assessment, resource coordination, and benefit-related inquiries.

Key Responsibilities

Primary Clinician: Manage a caseload of pediatric members with complex health needs, providing case management ranging from basic coaching to intensive support.

Clinical Assessments: Conduct telephonic clinical assessments, utilizing broad clinical and motivational interviewing skills to address the health and wellness needs of each member and family.

Care Planning: Develop and implement case-specific plans of care, setting both short- and long-term health goals.

Ongoing Communication: Maintain regular telephonic contact with each member to review progress, identify additional needs, and adjust care plans accordingly.

Collaboration with Providers: Coordinate with the member's treating provider and Home Health Agency to ensure comprehensive care.

Subject Matter Expertise: Provide education, consultation, and training to other clinicians within the organization as needed.

Resource Identification: Identify and connect members with online, telephonic, and community-based resources to support health goals.

Prevention and Wellness: Integrate lifestyle improvement and preventative health services into member interactions and coaching.

Compliance: Ensure all activities are documented in compliance with regulatory and business process requirements.

Face-to-Face Visits: For the most complex cases, conduct periodic face-to-face visits within the community. Qualifications & Requirements

Education: Bachelor's degree in Nursing, or RN certification with at least 3 years of experience in acute or managed care. Alternatively, a Case Management Certification.

Experience: 5+ years of relevant experience in case management, including experience with Medicaid or Medicare populations.

Licensing: Must be a licensed RN in the state of PA, or a Licensed Social Worker in PA.

Preferred Experience:

Pediatric care experience.

Familiarity with Child Protective Services (CPS).

Knowledge of community resources and preventive health services.

Certified Case Manager (CCM) preferred.

Skills & Abilities:

Strong verbal and written communication skills.

Ability to work independently and manage time effectively.

Compassionate and empathetic approach to patient care.

Excellent work ethic and attention to detail.

Experience with telephonic outreach and virtual care coordination.