As a Case Manager, you will support Idaho Medicaid participants through complex medical case management, patient navigation, and care coordination. The role focuses on developing individualized care plans that promote wellness, improve health outcomes, and reduce reliance on emergency services and inpatient care.
The Case Manager engages with members primarily by phone and email, while collaborating closely with healthcare providers, community resources, and interdisciplinary teams. This position supports diverse patient populations and plays a key role in helping members understand and access available benefits, services, and medically necessary care.
Core business hours are Monday through Friday, 9:00 a.m. to 5:30 p.m. Mountain Time, with flexibility required to meet member needs, including occasional non-business hours.
What you'll do:
- Performs assessments and evaluations of potential care management patients in accordance with client contractual obligations and/or state requirements.
- Collaborates with healthcare providers and ancillary service providers to validate appropriate treatment plans and identify patient education opportunities.
- Assessment and education activities may include face-to-face interactions for specific contracts. Effectively guides members to appropriate benefit information.
- Provides ongoing education to patients and communicates with healthcare providers to ensure the appropriateness of care.
- Recommends and implements adjustments to care plans as needed.
- Evaluates treatment adherence and reassesses patient commitment to necessary behavioral or lifestyle changes.
- Documents activities in accordance with contractual requirements, including individual member status, medical necessity reviews, and negotiations.
- Escalates issues through appropriate channels while adhering to established hierarchical protocols between clinical and non-clinical staff.
Required Skills and Experience:
- Bachelor’s degree in healthcare or a related field and/or equivalent training or experience.
- Current Registered Nurse (RN) or Master Social Worker (LMSW).
- Case Management Certification (CMC) required, or ability to obtain certification within two years of hire.
- Minimum of one (1) year of experience in human services and/or three (3) years of clinical practice experience.
Preferred Skills and Experience:
- Prior case management (CM), utilization management (UM), or care coordination experience strongly preferred.
Experience in human services is strongly preferred.
Positions working on specific contracts may require U.S. Citizenship.
Who We Are:
Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.
Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.
Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health.
Are you Ready?
We’re on a mission to transform lives and economies by improving health.
Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.
Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.
Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.
Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.
Thank you for your interest in Telligen!
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While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.
Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants.
Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.
Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class.
Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case-by-base basis.
If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to [email protected]
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
