Case Management Analyst

VIVA USA Inc; Springfield (IL); On-site; USD 60,000 - 82,000; Full time

Job summary

VIVA USA Inc. is seeking an Analyst, Case Management Field to support the Long Term Services & Supports (LTSS) team. This field-based role requires 50-75% travel to meet members face to face, with in-person quarterly visits and a full caseload to manage waiver members.

You will facilitate healthcare outcomes through care coordination, education, and use of care management tools and resources, ensuring compliance with contractual requirements and delivering member-centered support.

Qualifications

• Bachelor’s degree or Master’s in human-services fields (e.g., sociology, special education, rehabilitation counseling)

Responsibilities

• Evaluate referred members' needs/eligibility and recommend a plan.
• Identify high-risk factors and coordinate appropriate referrals.
• Coordinate and monitor care plan activities and progress.
• Consult with case managers and physicians to overcome barriers and review cases; multidisciplinary review for optimal outcomes.
• Identify and escalate quality of care issues.
• Use negotiation to secure options/services for member needs.
• Use motivational interviewing to engage members and promote healthy changes.
• Provide coaching and support to empower independent medical decisions.
• Help members participate with providers in decision-making.
• Utilize case management and quality management processes in compliance with regulatory guidelines.

Education

Bachelor’s degree or Master’s in human-services fields

Job description

Position Summary

This Analyst, Case Management Field position is with client’s Long Term Services & Supports (LTSS) team and is a field-based position out of the client. The requirements is for candidates to travel 50-75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.

Duties

Evaluation of Members

• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid 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.

Enhancement of Medical Appropriateness and Quality of Care

• 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 knowledgeably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care

• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Education

Individual with a bachelor’s degree or a non-licensed individual with a master’s degree, with either degree being in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling)

Notes

• Monday-Friday 8am-5pm


• Onsite as needed


• safety sensitive

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status