Maternity Case Manager

🔥 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

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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 Behavioral, Wellness, Specialty Prescription, Maternity, and other health scenarios • Develop strategic care plans by connecting members with specialized vendor partners and Allied Care Clinicians • Implement care plans by coordinating with members, clients, Allied staff, and specialized vendor partners • Collaborate with the Clinical Case Management team and other Case Managers to obtain clinical information • Present cases when needed to identify and troubleshoot escalated issues • Communicate with the Centers for Medicare and Medicaid Services (CMS) to obtain essential member information • Facilitate and maintain prescription drug vendor relationships • Negotiate pricing as needed, manage member setup, and provide ongoing support • Document cost savings and improvements in member health outcomes resulting from care plans • Perform weekly and monthly administrative tasks • Act as liaison between clients, brokers, members, Allied executives, and various departments • Troubleshoot and optimize internal processes within Enhanced Case Management and Allied departments • Perform 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 problems, 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 preferred but not required • Proficient with Microsoft Office Suite or related software • Standard desk role requiring extended sitting and computer work • Ability to communicate via telephone

🏖️ Benefits

• Medical Insurance • Dental Insurance • Vision Insurance • Life and Disability Insurance • Generous Paid Time Off • Tuition Reimbursement • Employee Assistance Program (EAP) • Technology Stipend • Flexible work-from-home arrangement • Cable broadband or fiber internet requirement with at least 100Mbps download/25Mbps upload to support remote work