RN or SW Case Manager

Case Manager – RN or SW 

Leading Insurance Company, ** Multiple Newly Created REMOTE Openings based in the Champaign, IL, Peoria, IL, Springfield IL, Bloomington, IL, East St. Louis, IL, Knox County, Logan County, Decatur, IL areas*** 

6 Month Contract to Perm

Remote positions – primarily phone contact, although some face to face visits will be required as well as regular meeting attendance.

General Duties:

  • Responsible for health care management and coordination of Insurance members in order to achieve optimal clinical, financial and quality of life outcomes.
  • Works with members to create and implement an integrated collaborative plan of care.
  • Coordinates and monitors insurance member’s progress and services to ensure consistent cost-effective care that complies with Company policy and all state and federal regulations and guidelines.
  • Provides case management services to members with chronic/complex conditions
  • Proactively identifies members that may qualify for case management services.
  • Conducts assessment of member needs by collecting in-depth information from the information system, the member, member’s family/caregiver, hospital staff, & physicians
  • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
  • Performs ongoing monitoring of the plan of care to evaluate effectiveness.
  • Documents care plan progress in the computer system.
  • Evaluates effectiveness of the care plan and modifies as appropriate
  • Measures the effectiveness of interventions to determine case management outcomes.
  • Promotes integration of services for members including behavioral health and long-term care to enhance the continuity of care
  • Conducts face to face or home visits as required.
  • Adheres to all documentation guidelines
  •  Attends regular staff meetings and Interdisciplinary Care Team (ICT) meetings.
  • Maintains professional relationships with provider community and customers
  •  Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
  • Complies with required workplace safety standards.

Knowledge/Skills/Abilities:

• Demonstrated ability to communicate, problem solve, and work effectively with people.

• Excellent organizational skill with the ability to manage multiple priorities.

• Work independently and handle multiple projects simultaneously.

• Strong analytical skills.

• Knowledge of applicable state, and federal regulations.

• Knowledge of ICD-10, CPT coding and HCPC.

• SSI, Coordination of benefits, and third-party liability programs and integration.

• Familiarity with NCQA standards, state/federal regulations and measurement techniques.

• In depth knowledge of CCA and/or other Case Management tools.

• Computer skills and experience with Microsoft Office Products.

• Excellent verbal and written communication skills.

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Required Education:

Bachelor’s degree in Nursing or Masters’ degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Experience:

1-2+ years of clinical experience with case management experience.

Required Licensure/Certification:

Active, unrestricted State Registered Nursing license or Licensed Clinical Social

Worker LCSW or Advanced Practice Social Worker APSW in good standing. A combination of experience and education will be considered in lieu of LCSW or APSW.

• Must have valid driver’s license with good driving record and be able to drive locally.

• Must pass Background Check