Case Manager - Complex Case Management

The Case Manager collaborates across Oscar teams to deliver high-quality care and improve member health outcomes. In this role, the Case Manager will educate members, evaluate Social Determinants of Health (SDOH), and connect individuals with community resources while contributing to process improvement initiatives and new pilot programs as required.

You will report into our Manager, Clinical Programs.

Responsibilities:

• Coordinate care across settings (inpatient, outpatient, ER, or home care) while maintaining strict confidentiality and high professional standards.
• Partner with members and providers to navigate complex health challenges and create personalized care plans that create better clinical outcomes.
• Assess and address Social Determinants of Health (SDOH) by connecting members with tailored community support resources.
• Provide crisis intervention support and act as a dedicated member advocate to resolve barriers to care and treatment compliance.
• Engage directly with members by phone, secure messaging, or in-person, to provide education on health conditions, hospital discharges, medical procedures, and new prescriptions.
• Compliance with all applicable laws and regulations.
• Other responsibilities as assigned.

Requirements:

• 2+ years of clinical experience to include hospital, outpatient, or community-based care management.
• 2+ years of experience working directly with patients with chronic medical conditions (e.g., diabetes, COPD, hypertension), demonstrating a solid understanding of disease trajectories, common treatment regimens, and symptom management.
• 1+ years experience in Care Coordination and Navigation.
• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license or Masters in Social Work (MSW) from a graduate of a Nationally Accredited School approved by the Council on Social Work Education.

Bonus Points:

• BSN
• Licensed Master Social Worker or Licensed Clinical Social Worker
• CCM Certification
• Case Management experience
• Complex Case Management certification
• Bilingual skills (Spanish)