Healthcare Case Manager, Complex Care

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $50k - $55k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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Allied Benefit Systems

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1980

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

Allied Benefit Systems is a national healthcare solutions company that provides health plan administration, care and cost management, provider network services, and data analytics to employers, members, and benefits consultants. The company focuses on reducing healthcare costs, optimizing plan performance, and improving member experience through administrative services, analytics & insights, and customizable provider networks.

📋 Description

• Review clinicals, claims and baseline case information for health scenarios such as Behavioral, Wellness, and Specialty Prescription, Maternity etc. • Develop strategic, initiative care plans to support members with varying health scenarios by connecting them to specialized vendor partners and Allied Care Clinicians that can facilitate the needs of the member. • Implement the care plan by coordinating with the member, client, Allied staff and/or the various specialized vendor partners. • Work closely with the Clinical Case Management team and other Case Managers to obtain clinical information needed to support the care plan. • Communicate with (CMS) to obtain essential member information. • Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member set-up, and provide on-going support. • Document the impact of the casework to highlight cost savings and the improvement of member health outcomes as a result of implanting a plan of care. • Perform assorted weekly and monthly administrative tasks. • Act as the liaison between the client/broker/member and Allied Executives and Various Departments. • Troubleshoot, identify, and collaborate to optimize internal processes within Enhanced Case Management and the various Allied departments. • Other duties as assigned.

🎯 Requirements

• Bachelor’s degree or equivalent work experience required. • 2 years of experience with Group Health Insurance and Self-Funded Health Plans required. • Excellent verbal and written communication skills. • Excellent interpersonal and customer service skills. • Excellent organizational skills and attention to detail. • Excellent time management skills with a proven ability to meet deadlines. • Ability to review information, assess the problem, and propose viable solutions. • Strong analytical and problem-solving skills. • Medicare, Medicaid, Case Management and prescription drug benefit experience preferred. • Experience in a clinical or social work position a plus. • Experience working in a hospital system a plus. • Life and Health Insurance Producers License is preferred, but not required. • Proficient with Microsoft Office Suite or related software.

🏖️ Benefits

• Medical • Dental • Vision • Life and Disability Insurance • Generous Paid Time Off • Tuition Reimbursement • EAP • Technology Stipend