The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Requires unrestricted driver's license and car
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
RN, LCSW, or LCPC with current unrestricted IL state licensure REQUIRED
3 years Clinical practice experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Case management and discharge planning experience preferred
Managed care/utilization review experience preferred
Crisis intervention skills preferred
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment