Case Management Field Analyst

VIVA USA Inc; Springfield (IL); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Fully remote

Job summary

VIVA USA Inc is seeking an Analyst, Case Management Field to support the LTSS team in a remote role with substantial travel. The role requires meeting members face-to-face and quarterly visits, managing a full caseload, and coordinating care with various health programs.

You will employ care management tools to educate and support members in making informed healthcare decisions and achieving outcomes, while ensuring regulatory compliance.

Qualifications

• Bachelor’s degree in a human-services field is required.
• Non-licensed candidates with a Master’s degree in a human-services field are acceptable.
• Strong ability to travel 50–75% and conduct field-based activities.

Responsibilities

• Evaluate members’ needs and determine a plan for case resolution.
• Coordinate and monitor care plan activities and progress.
• Provide coaching and support to empower members in healthcare decisions.
• Escalate quality of care issues through established channels.
• Utilize care management tools to support outcomes and regulatory compliance.

Education

Bachelor’s degree in human-services field

Master’s degree in human-services field

Tools

Microsoft Office

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:
• o 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.
• o 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.
• o Coordinates and implements assigned care plan activities and monitors care plan progress.
• o 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.
• o Identifies and escalates quality of care issues through established channels.
• o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• o Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• o Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
• o 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.

Preferred Qualifications

• Case management and discharge planning experience
• Managed Care experience
• Microsoft Office 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

• Monday-Friday; 8 am - 5 pm
• Fully remote (never coming onsite)
• 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