Analyst – Case Management – Field

Analyst – Case Management – Field

Requirements

• Candidate must reside in the Southwest Side of Chicago, IL (Applicable Zip Codes: 60402, 60513, 60534, 60632, 60609, 60629, 60638, 60458)
• Must possess reliable transportation, a valid drivers license, and be willing and able to travel up to 50-75% of the time to meet members face to face. Mileage is reimbursed per our company expense reimbursement policy
• 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus
• Bachelor’s Degree or non-licensed master level clinician required, with degree being in human services field. (Social Work, Psychology, Criminal Justice, Public Administration, Public Health, Human Services, Nursing, Sociology, Heath Services Administration, Behavioral Sciences)

Responsibilities

• Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Preferred Qualifications

• Case management and discharge planning experience
• Managed care experience
• Microsoft Office (Excel) experience