RN Case Manager – Behavioral Health

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

📋 Description

• Improve the quality of member management while maximizing member satisfaction and cost efficiency.

• Aid members in navigating the healthcare landscape as a cooperative health partner.

• Encourage wellness, resolve issues, and assist members in achieving their personal healthcare objectives.

• Conduct telephonic outreach to both members and providers.

• Gather, analyze, and report relevant data.

• Execute clinical reviews along with medical and behavioral health assessments.

• Record activities in adherence to federal and state regulations, NCQA standards, and company policies.

• Extract, organize, and analyze data to assess member eligibility for the Population Health Management Program.

• Coordinate and deliver timely, effective, equitable, safe, and member-focused care in accordance with HMO processes.

• Manage case assignments, which include outreach, documentation, monitoring progress, and closing cases.

• Comply with reporting and documentation standards, and engage in collaborative meetings with departmental staff and clients.

• Address barriers, social determinants, member motivators, and psychosocial challenges.

• Educate members on how to navigate the HMO and the broader healthcare system.

• Advocate for quality and cost-effective interventions and outcomes.

• Assist in the operational aspects of the division to fulfill customer needs and enhance satisfaction.

• Ensure the confidentiality of computer programs, medical records, and data.

• Participate in QM/UM Committee meetings, which encompass material preparation, minute-taking, data collection and analysis, reporting, and follow-up.

• Join off-hour/weekend call rotation if applicable.

• Commit to ongoing professional growth and education in line with current nursing practices and the Illinois Practice Act.

• Undertake additional assigned responsibilities and adapt to evolving annual program requirements.

⛳️ Requirements

• Valid Illinois Registered Nurse License.

• Illinois nursing professionals are required to complete 20 hours of continuing education every 2-year license renewal cycle.

• At least five years of experience across various healthcare environments.

• Extensive experience in case management and chronic condition management.

• Familiarity with utilization review, quality improvement, managed care, and/or community health.

• Prior remote and/or telephonic work experience is preferred.

• Fundamental understanding of case management principles, healthcare management, and reimbursement components.

• Proficient in motivational interviewing techniques.

• Exceptional clinical judgment.

• Highly adept in both verbal and written communication.

• Strong organizational, problem-solving, and time-management abilities.

• Capability to complete projects and assignments punctually.

• Ability to prioritize and respond to swiftly changing business demands.

• Capacity to work independently and remotely while multitasking in fast-paced environments.

• Proficient in word processing, spreadsheets, MS Word, Excel, Access, PDF, and Outlook.

• Experience in navigating multiple EMR systems.

• High-speed, secure home internet connection with at least 100 Mbps download and 10 Mbps upload speeds.

• Private, HIPAA-compliant home office with a locking door.

• Backup internet connection service options are required.

• Certification in Case Management is preferred but not mandatory.

• Must be reachable during designated working hours.

• Must disclose any secondary employment.

🏝️ Benefits

• Fully remote work arrangement.

• Comprehensive medical, dental, and vision insurance plans.

• 401(k) plan with a 3% employer match on the employee’s 6% contribution.

• Life and disability insurance coverage.

• Optional voluntary life insurance plans.

• Employee Assistance Program (EAP).

• Paid time off policies.

• Paid parental leave.

• Access to learning and development resources.

• Essential work equipment provided at no cost.

• Flexible work arrangements that minimize commuting time.