Care Management Specialist II

Job Title: Care Management Specialist II
Location: Remote – Must reside in TN, IL, NM, OK, MT, or TX
Duration: 3 Months+ (with possibility of extension)

Position Type:
Contract or Full-Time (depending on organization needs)
Remote Work: Yes (occasional local travel required)
 
Basic Function:
This position is responsible for discharge care coordination, episodic case management, and pre-admission/post-discharge counseling for members with acute medical conditions. The role focuses on facilitating smooth transitions of care, reducing readmissions, and ensuring members have access to needed education and resources.
The Discharge Care Coordinator will work independently and may also assist or train other staff. They will establish relationships with members during the immediate post-discharge period, address short-term care needs, and coordinate care across internal departments and external providers.
 
Essential Responsibilities:
Care Coordination & Transition Support:

• Perform discharge care coordination, pre-admission/post-discharge counseling, and episodic case management.
• Consult with physicians, facility discharge planners, and internal staff to identify appropriate care pathways and alternate treatment options.
• Provide education and resources to reduce emergency room visits and readmissions.

Member Outreach & Education:

• Engage members via phone or in-person visits to educate, assess needs, and provide short-term post-acute support.
• Address medication reconciliation and adherence.
• Reinforce provider post-discharge instructions (e.g., diet, activity, care protocols).

Navigation & Resource Support:

• Assist members in identifying or scheduling appointments with PCPs or specialists.
• Connect members with internal programs or community-based resources (transportation, home health, social services, etc.).
• Offer support in locating care centers, including Blue Distinction Centers.

Interdisciplinary Collaboration:

• Coordinate with providers, facilities, and internal teams to ensure care continuity.
• Develop alternative care plans as needed.
• Escalate complex cases to other departments such as Case Management or Disease Management.

Administrative & Compliance Duties:

• Document all care coordination activities in compliance with HIPAA and organizational policies.
• Participate in quality improvement initiatives and refer cases for quality review as needed.
• Maintain licensure and attend relevant trainings to stay up to date with clinical standards and regulations.

 
Job Requirements:

• Active, unrestricted license as a:
  • Registered Nurse (RN) OR
  • Licensed Master Social Worker (LMSW)
• License must be valid in one of the following states: TN, IL, NM, OK, MT, TX
• 2+ years of clinical experience
• 1+ year of health insurance or managed care experience
• Knowledge of medical management policies, discharge planning, and care coordination
• Excellent verbal and written communication skills
• Strong computer proficiency (PC, databases, EMR systems)
• Exceptional customer service and problem-solving abilities
• Must have a valid driver's license and reliable transportation for occasional travel

 
Preferred Experience:

• Prior experience in transition of care, home health, hospital discharge planning, or case management
• Knowledge of local community resources and healthcare regulations
• Bilingual (English/Spanish) is a plus

 
Licensing Notes:

• RNs in multi-state positions must obtain and maintain any required licenses in other states as determined by management (multi-state licensing fees covered by employer).
• LMSWs are not required to hold multi-state licenses.