Case Management Field Analyst

VIVA USA Inc; Naperville (IL); On-site; USD 55,000 - 75,000; Full time

Job summary

VIVA USA Inc is seeking a Travel-based Analyst, Case Management Field to support LTSS members. This role requires 50-75% travel, in-person visits, and a full caseload with a focus on care coordination and education.

You will collaborate with care teams, document progress, and ensure regulatory compliance while guiding members toward optimal health outcomes.

Qualifications

• Two years of case management experience.
• Valid IL Driver’s license and ability to travel up to 75%.
• Experience with Microsoft Office and electronic health records.

Responsibilities

• Evaluate members’ needs and determine care approach using care management tools.
• Identify high risk factors and service needs and refer to appropriate clinical management.
• Coordinate and implement care plan activities and monitor progress.
• Collaborate with medical directors and case managers to improve outcomes.
• Identify and escalate quality of care issues through established channels.
• Negotiate options and services to meet members’ benefits and healthcare needs.
• Use motivational interviewing to engage members and promote healthy choices.
• Educate and empower members to participate in healthcare decisions.
• Document care processes in compliance with regulations and policies.

Skills

Case management

MS Office

EHR experience

Driving

Communication

Education

Bachelor’s or Master’s in human-services

Tools

EHR systems

Job description

Travel 50-75% of the time to meet with members face to face.

This Analyst, Case Management Field position is with the Client’s Long Term Services & Supports (LTSS) team and is a field-based position. 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.

Experience

• Valid IL Driver’s license
• Willing and able to travel up to 75% of their time to meet with members face to face
• Reliable Transportation required, eligible for mileage reimbursement as per company policy.
• Minimum of two (2) years of case management experience
• Microsoft Office and electronic health record experience

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

• M-F 8 a.m. - 5 p.m.
• Travel 50-75% of the time to meet with members face to face.

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