Case Manager – Maternity

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Assist members in navigating their healthcare requirements by coordinating care plans and linking them with clinical resources, specialized services, and vendor partners.

• Analyze clinical documentation, claims, and baseline case data for behavioral health, wellness, specialty prescription medications, maternity, and various health needs.

• Create strategic care plans and connect members with specialized vendor partners and Allied Care Clinicians.

• Execute care plans by collaborating with members, clients, Allied staff, and vendor partners.

• Work in partnership with the Clinical Case Management team and other case managers to gather clinical information.

• Present cases to collaboratively identify and address escalated casework issues.

• Communicate with CMS to secure vital member information.

• Build and maintain relationships with prescription drug vendors, negotiate pricing as necessary, manage member setup, and provide ongoing support.

• Record casework impact, including cost savings and enhancements in member health outcomes.

• Carry out weekly and monthly administrative tasks.

• Act as a liaison among clients, brokers, members, Allied executives, and Allied departments.

• Identify and resolve process issues while collaborating to enhance internal processes.

• Perform additional tasks as assigned.

⛳️ Requirements

• A bachelor's degree or equivalent work experience is mandatory.

• A minimum of two years of experience with group health insurance and self-funded health plans is required.

• Exceptional verbal and written communication abilities.

• Outstanding interpersonal and customer service skills.

• Strong organizational skills and meticulous attention to detail.

• Excellent time management skills, with a proven record of meeting deadlines.

• Capability to review information, evaluate problems, and suggest viable solutions.

• Strong analytical and problem-solving capabilities.

• Proficiency in Microsoft Office Suite or similar software.

• Experience with Medicare, Medicaid, case management, and prescription drug benefits is preferred.

• Background in a clinical or social work role is advantageous.

• Experience within a hospital system is a plus.

• A life and health insurance producer’s license is preferred but not mandatory.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment fostering teamwork and collaboration.