Case Manager Jobs

About The Position

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.