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