Duties
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Experience
Minimum 3-5 years clinical practical experience preferred
Minimum 2-3 years Care Management, discharge planning and/or home health care coordination experience preferred
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills.
Ability to work independently
Effective computer skills including navigating multiple systems and keyboarding
Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications
Position Summary
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Requires unrestricted driver's license and car
Requires an RN with unrestricted active license
Education
RN, LCSW, or LCPC with current unrestricted IL state licensure REQUIRED
What days & hours will the person work in this position? List training hours, if different.
Monday-Friday 8am-5pm CST
