Case Manager (Maternity) - Remote

Allied Benefit Systems•Chicago, IL

4d•$50,000 - $55,000•Remote

About The Position

The Case Manager (Maternity) helps members navigate healthcare needs by coordinating care plans and connecting them with clinical resources, specialized services, and vendor partners. As part of Allied’s Enhanced Case Management (ECM) team, the Case Manager reviews clinical documentation and claims information, identifies appropriate referrals, and collaborates with clinicians and other case managers to support members’ care needs. The role serves as a coordination point among members, clients, brokers, vendors, and Allied’s internal teams. It facilitates communication, resolves case-related issues, supports care-plan implementation, and documents case activity. The Case Manager also evaluates the effects of services on member health outcomes and costs and identifies opportunities to improve care coordination and the member experience.

Requirements

Bachelor’s degree or equivalent work experience.
Two years of experience with group health insurance and self-funded health plans.
Excellent verbal and written communication skills.
Excellent interpersonal and customer service skills.
Excellent organizational skills and attention to detail.
Excellent time management skills and a proven ability to meet deadlines.
Ability to review information, assess problems, and propose viable solutions.
Strong analytical and problem-solving skills.
Proficiency with Microsoft Office Suite or related software.

Nice To Haves

Experience with Medicare, Medicaid, case management, and prescription drug benefits.
Experience in a clinical or social work position.
Experience working in a hospital system.
A life and health insurance producer’s license.

Responsibilities

Review clinical documentation, claims, and baseline case information to identify health needs related to behavioral health, wellness, specialty prescription medications, maternity, and other areas.
Develop strategic care plans by connecting members with specialized vendor partners and Allied Care Clinicians.
Implement care plans in coordination with members, clients, Allied staff, and specialized vendor partners, as appropriate.
Work with the Clinical Case Management team and other case managers to obtain clinical information needed to support care plans.
Present cases as needed to collaboratively identify and resolve escalated casework issues.
Communicate with CMS to obtain essential member information.
Facilitate and maintain relationships with prescription drug vendors, negotiate pricing as needed, manage member setup, and provide ongoing support.
Document the impact of casework, including cost savings and improvements in member health outcomes resulting from care-plan implementation.
Perform weekly and monthly administrative tasks.
Serve as a liaison among clients, brokers, members, Allied executives, and Allied departments.
Identify and troubleshoot process issues and collaborate with the ECM team and other Allied departments to optimize internal processes.
Perform other duties as assigned.