Case Management Specialist in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Case Management Specialist based in the United States.

This full-time remote role supports members through coordinated, compassionate, and accessible healthcare services.
You will work as part of an interdisciplinary care team, helping members address health needs, social barriers, and gaps in preventive care.
A significant portion of the role involves direct telephone engagement, outreach, assessment, care planning, and ongoing coordination.
You will help connect members with healthcare benefits, community resources, and services that support their overall well-being.
The position combines member advocacy, detailed documentation, healthcare technology, and close collaboration with clinical professionals.
Success requires empathy, organization, accountability, strong communication, and the ability to engage members who may be difficult to reach.
You will work in a structured, metrics-driven environment while maintaining compliance with healthcare regulations and privacy standards.

• Engage with members by telephone for approximately 50–75% of the workday, providing support, education, and care coordination.
• Conduct outreach using available tools and resources to locate, engage, and support members who may be difficult to reach.
• Complete health risk assessments and evaluate members' needs, including social determinants of health, preventive care, and health-maintenance requirements.
• Partner with members to develop individualized care plans containing appropriate goals, interventions, and actions based on identified needs.
• Monitor care-plan activities and follow up with members to help ensure identified needs and care gaps are addressed.
• Identify and connect members with relevant health plan benefits, community programs, healthcare services, and other available resources.
• Collaborate closely with Registered Nurse Care Managers, Care Coordinators, Social Workers, and other interdisciplinary care team members to address barriers and support optimal outcomes.
• Consult with the Care Manager RN regarding clinical considerations, medication-related information, and supportive clinical decision-making.
• Leverage clinical expertise from nursing colleagues to ensure member needs are appropriately assessed and addressed.
• Maintain complete, accurate, and timely documentation of care-management activities within electronic health records and related systems.
• Meet applicable state and federal regulatory requirements and complete assigned activities within required timelines.
• Consistently achieve established performance and productivity expectations, including call volume, member engagement, and regulatory metrics.
• Support team objectives, operational improvements, special projects, and initiatives designed to enhance the quality and efficiency of member care.
• Assist with mentoring or onboarding new team members when needed.
• Maintain secure handling of member information and follow applicable privacy, security, and healthcare compliance requirements.
• Use multiple healthcare and productivity applications simultaneously to support efficient workflows and accurate recordkeeping.

• 2+ years of experience in a health-related field.
• 2+ years of customer service experience, preferably in a healthcare or member-support environment.
• Associate's degree and relevant experience in a healthcare-related field is required.
• A practical nursing degree or certificate with active licensure meeting applicable state requirements, or a bachelor's degree in healthcare or a related field, is preferred.
• Experience providing care management services to Medicare and/or Medicaid members is preferred.
• Experience supporting individuals with social determinants of health needs, chronic medical conditions, and/or behavioral health needs is preferred.
• Experience conducting health-related assessments and supporting individualized care-planning processes is preferred.
• Bilingual communication skills, particularly English and Spanish, are a plus.
• Proficiency with Microsoft Office tools, including Word, Excel, Outlook, OneNote, and Teams.
• Strong verbal and written communication skills, with the ability to explain information clearly and build trust with members.
• Excellent customer service and member-engagement skills, combined with empathy, professionalism, and patience.
• Ability to work independently, exercise sound judgment, and maintain consistent productivity in a remote environment.
• Strong organization and time-management skills, with the ability to manage multiple member interactions and administrative responsibilities.
• Familiarity with community resources and services, or the willingness to develop this knowledge.
• Ability to learn and apply care-management practices within Medicare and Medicaid managed-care environments.
• Comfortable navigating multiple monitors, applications, secure systems, EHR portals, and digital communication platforms.
• Ability to follow cybersecurity practices, including VPN access, secure passwords, device security, and recognition of suspicious emails or links.
• Ability to troubleshoot routine technology issues independently and escalate unresolved issues appropriately.
• Willingness to learn new technologies, processes, and skills as the remote work environment evolves.
• Ability to maintain a quiet, private, secure, and dedicated workspace that permits uninterrupted work and complies with applicable HIPAA requirements.
• Ability to maintain a direct, hardwired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
• Ability to work from the state and city where residency has been confirmed and to maintain separate care arrangements for dependents during working hours.

• Full-time schedule of 40 hours per week.
• Base pay range of $21.10–$40.90 per hour, with actual compensation determined by experience, education, geography, and other relevant factors.
• Eligibility for a bonus, commission, or short-term incentive program.
• Medical, dental, and vision coverage, subject to eligibility.
• Paid time off.
• Retirement savings options.
• Wellness programs and resources supporting physical, emotional, and financial well-being.
• Employer-provided equipment, including computer, monitor, keyboard, and headset.
• Fully remote work arrangement for eligible U.S. locations.
• Dedicated resources and support for remote work.
• Opportunities to develop healthcare, care-management, technology, and member-engagement skills.
• Collaborative interdisciplinary environment focused on improving healthcare experiences and outcomes.
• Inclusive workplace committed to valuing colleagues and fostering a strong sense of belonging.