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