Case Manager Remote Cleveland, OH Contract

Case Manager |

Remote | Cleveland, OH | Contract Business & Care Management Long Beach, California Contract Dec 16, 2025 Case Manager|

Remote | Akron, OH | Contract Walker Healthforce is seeking a Coverage Review Pharmacist with at least 1 year of case management experience. This is a 3-month contract opportunity. CORE REQUIREMENTS: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously.

Strong analytical skills. Knowledge of applicable state, and federal regulations. Knowledge of ICD-9, CPT coding and HCPC. SSI, Coordination of benefits, and Third Party Liability programs and integration. Familiarity with NCQA standards, state/federal regulations and measurement techniques. In depth knowledge of CCA and/or other Case Management tools. Ability to take initiative and see tasks to completion. Computer skills and experience with bolthires Office Products. Excellent verbal and written communication skills.

Ability to abide by Molinas policies. Able to maintain regular attendance based upon agreed schedule. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. WE CONSIDER IT A BONUS IF YOU ALSO HAVE: 0-2 years of clinical experience with case management experience Must have RN, LSW or LISW licensure Bachelors degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree) JOB RESPONSIBILITIES: Provides case management services to members with chronic or complex conditions including: Proactively identifies members that may qualify for potential case management services.

Conducts assessment of member needs by collecting in-depth information from Molinas information system, the member, members family/caregiver, hospital staff, physicians and other providers. Identifies, assesses and manages members per established criteria. Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs. Performs ongoing monitoring of the plan of care to evaluate effectiveness.

Documents care plan progress in Molinas information system. Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes. Measures the effectiveness of interventions to determine case management outcomes. Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members. Conducts face to face or home visits as required. Maintains department productivity and quality measures. Manages and completes assigned work plan objectives and projects in a timely manner.

Demonstrates dependability and reliability. Maintains effective team member relations. Adheres to all documentation guidelines. Attends regular staff meetings. Participates in Interdisciplinary Care Team (ICT) meetings. Assists orientation and mentoring of new team members as appropriate. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.

Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth. Complies with required workplace safety standards. WHAT WE OFFER: Competitive compensation package Weekly pay via Direct Deposit Medical, Dental & Vision available 401k options WHY WORK WITH WALKER? Access to our top ranked team of recruiting and placement specialists Continuous, one-on-one support from a dedicated engagement manager

Professional resume development and interview preparation Contact our Recruiting Team today to experience the Walker Healthforce difference!

ABOUT US: Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we're custom not commodity and we've been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today! We are an Equal Opportunity Employer committed to a culturally diverse workforce.

All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status. #IND1 Apply tot his job

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