Manager, Enhanced Case Management

Allied Benefit Systems•Chicago, IL

1d•$75,000 - $85,000•Remote

About The Position

The Manager, Enhanced Case Management (ECM) leads the development, delivery, and continuous improvement of the ECM program, ensuring high quality care coordination and advocacy for member with complex health needs. This role provides direct leadership and mentorship to the ECM team, evaluates and enhances departmental workflows, and fosters strong internal and external partnerships through exceptional communication and relationship building skills. The Manager maintains expertise in self funded benefits administration and government programs such as Medicare and Medicaid to guide members in understanding and optimizing their available coverage options. In addition to managing a limited caseload, the position addresses client inquiries, resolves member escalations, and collaborates with organizational leadership to strengthen program strategy, performance, and impact.

Requirements

Bachelor's degree or equivalent work experience required.
At least 5 years of Case Management experience, preferably from a third-party administrator, carrier, or within the healthcare industry required.
At least 3 years at a supervisor level and successfully demonstrated leadership competencies required.
Demonstrated expertise in Medicaid, Medicare, eligibility processes, and coordination of benefits.
Experience managing teams of employees with a variety of backgrounds and tenure.
Ability to monitor and prioritize multiple deadlines and projects simultaneously.
Comfortable managing competing priorities and guiding others in a fast-paced environment.
Excellent written and verbal communication skills with the ability to influence cross-functionally and present to clients/leadership

Nice To Haves

Experience reading, analyzing, and reviewing organizational metrics and data, preferred.
Proven experience building training programs, conducting audits, and providing structured feedback.

Responsibilities

Develops and directly manages Enhanced Case Management Advocates and Supervisors, while providing indirect oversight to the Case Managers through supervisory staff.
Monitors department dashboards and conducts case audits to ensure teams consistently meet or exceed quality standards and KPIs.
Fosters a collaborative, continuous improvement environment and supports staff in resolving challenges and enhancing performance through constructive, supportive feedback.
Engage with the Client Management and Value Team to offer insight related to high-dollar claimants and provide a clear explanation of ECM strategies, efforts, and impact.
Identify members from our ASO Self-Funded and Co-Sourcing Partially Self-Funded Clients based on current medical condition(s), future claim costs, and current financial assessment for Enhanced Case Management evaluation and identify strategic solutions.
Maintain continuous knowledge of Medicare, Medicaid, and other government programs, including application processes, eligibility criteria, dual eligibility, and coordination of benefits (COB).
Identify trends and opportunities to collaborate with Medical Management leadership to enhance processes and strategies to improve quality, efficiency, and outcomes.
Manage a case load of high-complexity members to support their needs, evaluate coverages and offer resources.
Promotes an environment of continuous improvement and collaboration and assists in troubleshooting and resolving escalated challenges quickly by utilizing an empathetic approach.
Coordinate with Client Management and other internal departments to answer questions and resolve client challenges.
Assist in selecting and building the right teams to meet long-term talent planning needs and achieve business goals.
Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
Actively engage, coach, counsel and provide timely, and constructive performance feedback.
Performs other related duties as assigned.