Healthcare Case Manager, Complex Care

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

📋 Description

• Evaluate clinical data, claims, and foundational case details for various health scenarios, including Behavioral, Wellness, Specialty Prescription, Maternity, and more.

• Create strategic, initiative-based care plans to assist members facing diverse health issues by linking them with specialized vendor partners and Allied Care Clinicians who can address their needs.

• Execute the care plan by collaborating with the member, client, Allied staff, and various specialized vendor partners.

• Collaborate closely with the Clinical Case Management team and other Case Managers to gather the clinical information necessary to support the care plan.

• Communicate with the Centers for Medicare & Medicaid Services (CMS) to secure vital member information.

• Manage and maintain relationships with prescription drug vendors, negotiate pricing when needed, oversee member set-up, and provide ongoing support.

• Document the outcomes of the casework to showcase cost savings and improvements in member health resulting from the implementation of a care plan.

• Carry out various weekly and monthly administrative responsibilities.

• Serve as the connection between the client/broker/member and Allied Executives as well as various departments.

• Identify and troubleshoot issues while collaborating to enhance internal processes within Enhanced Case Management and the different Allied departments.

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor’s degree or equivalent work experience is required.

• A minimum of 2 years of experience in Group Health Insurance and Self-Funded Health Plans is required.

• Exceptional verbal and written communication skills.

• Outstanding interpersonal and customer service abilities.

• Strong organizational skills and meticulous attention to detail.

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

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

• Robust analytical and problem-solving skills.

• Experience with Medicare, Medicaid, Case Management, and prescription drug benefits is preferred.

• Background in a clinical or social work role is an advantage.

• Experience within a hospital system is a plus.

• A Life and Health Insurance Producers License is preferred but not mandatory.

• Proficient in Microsoft Office Suite or similar software.

🏝️ Benefits

• Medical

• Dental

• Vision

• Life and Disability Insurance

• Generous Paid Time Off

• Tuition Reimbursement

• Employee Assistance Program (EAP)

• Technology Stipend