Case Manager, RN/LCSW

Description & Requirements

The Case Manager provides comprehensive coordination of services for service members and their families. This role coordinates patient care and documentation pathways and serves as a liaison between military and civilian medical and non-medical agencies to support continuity of care. The RN Case Manager conducts assessments, planning, and evaluation of care to promote optimal health and support successful transitions back to duty or into the civilian community. Candidates must live in or near Camp Pendleton, CA; Coronado, CA; Cannon AFB, NM; Dam Neck, VA; JEB Little Creek, VA; Fort Benning, GA; Fort Bragg, NC; Fort Campbell, KY; Fort Carson, CO; Joint Base Lewis-McChord, WA; Homestead AFB, FL; Hurlburt Field, FL; Eglin AFB, FL; or MacDill AFB, FL. U.S. citizenship is required. Candidates must possess an active U.S. Government Secret security clearance or be eligible to obtain and maintain a Secret security clearance as required for contract performance. This position is pending upon contract award. Why Maximus? ⚖️ Flexibility That Fits Your Life – Work/life balance support with flexibility designed to meet your personal and professional needs. 🏥 Robust Health & Insurance Benefits – Choose from a variety of Medical, Dental, Vision, and Prescription plans, plus a partially funded HSA. You’ll also have access to Life Insurance and discounts on Auto, Home, Renters, and Pet Insurance. 💰 Build Your Financial Future – Take advantage of our 401(k) Retirement Savings Plan with Company Match to help you plan for what's ahead. 🌴 Generous Time Away From Work – Recharge with PTO, paid holidays, extended sick leave, and Short and Long Term Disability coverage. 💙 Wellness Beyond the Workplace – Access resources that support your physical, emotional, and financial well-being through our Employee Assistance Program (EAP). 👏 Recognition That Matters – Celebrate achievements and recognize colleagues through our employee recognition platform. 🎓 Invest in Your Growth – Continue your education and professional development with Tuition Reimbursement opportunities. 🎁 Employee Discounts & Perks – Enjoy exclusive savings, special offers, and additional employee-only benefits. 🌿 Wellness Programs & Resources – Explore a variety of programs and tools designed to support your overall health and wellness. 📈 Career Development Opportunities – Enhance your skills through training programs, workshops, conferences, and ongoing learning opportunities. 📜 Licensure & Certification Support – Maximus covers the costs associated with renewing required licenses and certifications.

Essential Duties and Responsibilities: - Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations. - Render medical necessity determinations for Medicare State East cases assigned. - Resolve all other technical issues within Medicare reconsideration assigned. - Review cases to determine and summarize facts of each case assigned and assess issues involved in the case. - May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary. - Be the Subject Matter Expert (SME) for project. - Perform other duties as assigned by management.

- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care. - Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff. - Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries. - Knowledge of the healthcare financial environment and the fiscal dimension of