Case Management Specialist – LPN

Job Title: Case Management Specialist – LPN
Location: Toledo, OH and Immediate Surrounding Counties
Schedule: Monday – Friday, 8:00 AM – 5:00 PM
 

Position Summary:

The Care Manager Specialist is a vital member of the Care Team responsible for managing care coordination for members enrolled in Dual Special Needs Plans (DSNP). The position focuses on members with low to medium clinical stratification or those experiencing significant Social Determinants of Health (SDOH) needs. The role requires collaboration with other care team members including Nurse Care Managers, Care Coordinators, and Transition of Care Coaches to help improve member health outcomes, close care gaps, and connect members with essential community resources.

Key Responsibilities:

• Conduct health screenings and market-specific assessments.

• Engage and support members through telephonic and in-person outreach.

• Ensure members understand and receive their prescribed medications.

• Manage caseloads in compliance with monitoring and contact frequency guidelines.

• Assist in coordination of care, including prior authorizations, condition education, and specialist/provider communication.

• Identify and address health and social risk factors through evaluations and intervention strategies.

• Present complex cases in interdisciplinary team meetings.

• Collaborate with internal and external resources to facilitate overall care coordination.

• Maintain accurate, up-to-date individualized care plans reflecting current member needs.

• Support members through transitions of care and follow-up appointments.

• Educate members on plan benefits and available community supports.

• Document interactions and maintain compliance with operational standards.

Qualifications:

• Licensure: Active, unrestricted LPN license in the state of Ohio.

• Education: High school diploma or equivalent required.

• Experience:

  • Minimum 2 years of LPN nursing experience (3+ years preferred).

  • Experience working with Medicaid/Medicare populations and DSNP plans is a plus.

• Skills & Abilities:

  • Proficiency in Microsoft Office applications (Word, Excel, Outlook).

  • Strong organizational and communication skills.

  • Ability to work independently and maintain professional relationships with members and team.

  • Knowledge of community-based services and care management best practices.

  • Experience managing sensitive health information and working with diverse populations.

Other Requirements:

• Dedicated and secure home workspace (for telephonic/remote work if applicable).

• Reliable transportation for occasional in-person visits as needed.

• Regular and dependable attendance.