Case Manager RN coordinating health services for Medicare and Medicaid populations. Collaborating with members and providers to meet health and social needs in Illinois.
Responsibilities
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities
Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work
Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care
Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate
Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person
Prepares all required documentation of case work activities as appropriate
Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes
Provides educational and prevention information for best medical outcomes
Utilizes case management processes in compliance with regulatory and company policies and procedures
Monitors member/client progress toward desired outcomes through assessment and evaluation.
Requirements
Minimum 3-5 years clinical practical experience preference required
Minimum 2-3 years CM, discharge planning and/or home health care coordination experience
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
Efficient and Effective computer skills including navigating multiple systems and keyboarding
Candidates must live in or near Arlington Heights, Rolling Meadows, Glenview, Palatine, Mount Prospect, Northbrook, Wooddale, Prospect Heights
Must possess reliable transportation and be willing and able to travel up to 75% of the time.
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings
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