**Job Description: Care Management Specialist (Remote)** **Pay Rate: 30/Hr on W2** **Duration: 3+ Month on W2** **Location: Remote (1 week of onsite training will be there at Percival Road office in Columbia SC for the first week)** **Position Overview** The Care Management Specialist is responsible for assessing, coordinating, and evaluating healthcare services to ensure members receive appropriate, high-quality, and cost-effective care. This role applies clinical expertise, administrative policies, and established criteria to manage medical or behavioral health eligibility, provide case management, and ensure compliance with regulations and benefits guidelines. **Key Responsibilities** 1. Conduct active case management by assessing service needs and developing action plans in collaboration with members. 2. Monitor service plans, evaluate outcomes, and ensure documentation of clinical information for medical necessity and benefit determination. 3. Provide telephonic support and education for members with chronic conditions, high-risk pregnancies, or other at-risk conditions. 4. Utilize motivational interviewing techniques to support behavior change and enhance program engagement. 5. Perform medical or behavioral reviews to ensure requested services meet benefit and medical necessity guidelines. 6. Utilize resources for review determinations and make referrals to appropriate staff, such as Medical Directors or Case Managers. 7. Input clinical data into systems to support claims adjudication and information flow. 8. Provide direct education and intervention for members and providers regarding healthcare delivery systems, network utilization, and benefit plans. 9. Identify and initiate on-site reviews and advocate for members through communication and education. 10. Encourage enrollment in care management or disease management programs. 11. Stay informed about contracts, network statuses, and provider information to apply appropriately in care management. 12. Assist with claims discussions or resolutions and refer to internal teams for processing authorized or unauthorized services. 13. Maintain compliance with applicable regulations, including ERISA, NCQA, URAC, and state/federal guidelines. **Qualifications** + **Education** : Associate degree - Nursing, OR, Graduate of Accredited School of Nursing, OR, Master's degree in Social Work (for Div. 6B or Div. 75) or Master's in Psychology, or Counselling (for Div. 75 only). + **Required Experience: 4** years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. + **Required License/Certificate** : An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as social worker from the United States and in the state of hire (in Div. 6B) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager If this is a role that interests you and you’d like to learn more, c **lick apply** now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you! **About ManpowerGroup, Parent Company of:** **Manpower, Experis, Talent Solutions, and Jefferson Wells** _ManpowerGroup® (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We develop innovative solutions for hundreds of thousands of organizations every year, providing them with skilled talent while finding meaningful, sustainable employment for millions of people across a wide range of industries and skills. Our expert family of brands –_ **_Manpower, Experis, Talent Solutions, and Jefferson Wells_** _–_ creates substantial value for candidates and clients across more than 75 countries and territories and has done so for over 70 years. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2022 ManpowerGroup was named one of the World's Most Ethical Companies for the 13th year - all confirming our position as the brand of choice for in-demand talent. ManpowerGroup is committed to providing equal employment opportunities in a professional, high quality work environment. It is the policy of ManpowerGroup and all of its subsidiaries to recruit, train, promote, transfer, pay and take all employment actions without regard to an employee's race, color, national origin, ancestry, sex, sexual orientation, gender identity, genetic information, religion, age, disability, protected veteran status, or any other basis protected by applicable law.