Case Manager Long-term Care (Delaware)

Highmark Health

Job Overview

Location

DE, Working at Home - Delaware

Job Type

Full-time

Full Job Description

📋 Description

• Serve as the single point of contact for members enrolled in DSHP Plus LTSS and DSNP to coordinate all care needs across service delivery systems and community supports.
• Conduct regular in-home and nursing facility visits to perform face-to-face needs assessments, followed by telephonic follow-ups in accordance with state and national guidelines.
• Assess, plan, coordinate, implement, and evaluate care for members with chronic, complex health care, social service, and custodial needs in both nursing facility and home/community-based settings.
• Coordinate care across the continuum of services to address members’ physical, behavioral, long-term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive, and most cost-effective manner.
• Authorize LTSS services based on comprehensive needs assessments and coordinate home and community-based services (HCBS), Medicaid, and DSNP benefits.
• Facilitate transitions between care settings, including hospital-to-home and nursing facility-to-community, using an integrated care team to meet individual member needs.
• Educate members and caregivers on health care needs, available benefits, resources, and long-term care service options.
• Develop individualized care plans in collaboration with members or caregivers to identify services that align with their specific needs and goals.
• Identify and facilitate referrals to specialized programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
• Collaborate with members’ health care teams—including physical and behavioral health providers, integrated care teams (ICT), and discharge planners—to ensure coordinated, safe, and effective care.
• Assist members in developing and implementing backup plans to address gaps in provider coverage.
• Ensure approved support services are delivered as outlined in the member’s plan of care.
• Evaluate the effectiveness of service plans and make revisions in compliance with company policy, state contractual requirements, and regulatory standards.
• Connect members with community resources and formulate action plans to overcome obstacles to optimal care.
• Accurately document all case management services, interventions, and communications in the electronic health record.
• Adhere to all company, state, and federal requirements including HIPAA, privacy practices, and quality performance standards.
• Travel frequently within assigned territory in Delaware to members’ homes, nursing facilities, and community-based settings.
• Maintain a dedicated home workspace used exclusively for business purposes and comply with all telecommuter policies.
• Work flexible hours to accommodate members’ needs and meet regulatory deadlines.
• Lift up to 10 pounds constantly, 10 to 25 pounds occasionally, and 25 to 50 pounds rarely.
• Teach or train others on a regular but occasional basis.

🎯 Requirements

• Bachelor’s degree in Social Work or health/human/education services with 3 years of experience in long-term care, home health, hospice, public health, or assisted living OR
• Master’s degree in Social Work or health/human/education services with 1 year of experience in long-term care, home health, hospice, public health, or assisted living OR
• Current State RN or LPN licensure or multi-state eNLC licensure with 2 years of experience in long-term care, home health, hospice, public health, or assisted living OR
• High school diploma or equivalent with 3 years of qualifying case management experience with the aged, behavioral health conditions, or persons with physical/developmental disabilities or HIV/AIDS
• Reliable daily transportation to travel within assigned Delaware territory
• Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)

🏖️ Benefits

• Base pay range of $72,700 to $116,600 annually
• Working from home position with required in-person field travel
• Dedicated home workspace requirement for business use
• Compliance with HIPAA and company data security policies
• Opportunity to work with vulnerable populations including those with behavioral health, developmental disabilities, or HIV/AIDS
• Access to managed care and Medicaid/DSNP systems

Skills & Technologies

Onsite

Degree Required

Ready to Apply?

Apply Externally

You will be redirected to an external site to apply.

AI Job Fit Analysis

Pro

See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.

Highmark Health

Visit Website

About Highmark Health

Highmark Health is a Pittsburgh-based integrated health care delivery and financing system. It combines the Highmark Inc. insurance business with Allegheny Health Network hospitals and physicians, plus a growing portfolio of health services companies. The not-for-profit system serves millions of members across Pennsylvania, West Virginia, Delaware, and New York, offering medical, pharmacy, dental, vision, and behavioral health benefits while operating inpatient and outpatient facilities, research programs, and community health initiatives aimed at improving population health outcomes.

View Company Profile

Get more remote jobs like this

Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.

Weekly remote jobs and featured talent.

No spam. Only curated remote roles and product updates. You can unsubscribe anytime.