Maternity Case Manager

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

📋 Description

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

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

• Execute care plans through coordination with members, clients, Allied staff, and specialized vendor partners.

• Work alongside the Clinical Case Management team and other Case Managers to gather clinical information.

• Present cases as necessary to identify and resolve escalated issues.

• Interact with the Centers for Medicare and Medicaid Services (CMS) to acquire vital member information.

• Manage and sustain relationships with prescription drug vendors.

• Negotiate pricing as required, oversee member setup, and offer continuous support.

• Record cost savings and enhancements in member health outcomes stemming from care plans.

• Conduct weekly and monthly administrative responsibilities.

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

• Diagnose and improve internal processes within Enhanced Case Management and Allied departments.

• Carry out other tasks as assigned.

⛳️ Requirements

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

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

• Exceptional verbal and written communication abilities.

• Strong interpersonal and customer service skills.

• Outstanding organizational skills and meticulous attention to detail.

• Excellent time management skills with a demonstrated ability to meet deadlines.

• Capacity to analyze information, evaluate problems, and suggest practical solutions.

• Strong analytical and problem-solving capabilities.

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

• Clinical or social work experience is a plus.

• Experience within a hospital system is advantageous.

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

• Proficient in Microsoft Office Suite or similar software.

• Standard desk role requiring prolonged periods of sitting and computer use.

• Ability to communicate via telephone.

🏝️ Benefits

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life and Disability Insurance

• Generous Paid Time Off

• Tuition Reimbursement

• Employee Assistance Program (EAP)

• Technology Stipend

• Flexible work-from-home arrangement

• Requirement for cable broadband or fiber internet with a minimum of 100Mbps download/25Mbps upload to facilitate remote work