Case Manager I

Allied Benefit Systems; Chicago (IL); Remote; USD 48,000 - 50,000; Full time

Job summary

Join a forward-thinking company as a Case Manager I, where you will play a crucial role in enhancing member experiences through effective communication and coordination. This position focuses on supporting the Enhanced Care Advocate and ECM team, ensuring members receive the best possible care options. With responsibilities ranging from liaising with vendors to analyzing reports, you will be integral in improving internal processes and member satisfaction. If you have a passion for healthcare and possess strong organizational skills, this is an exciting opportunity to make a significant impact in the lives of many.

Qualifications

• 2+ years of experience in Group Health Insurance and Self-Funded Health Plans.
• Strong communication and customer service skills.

Responsibilities

• Identify and communicate coverage options to members.
• Coordinate with members, clients, and vendors.

Skills

Group Health Insurance

Self-Funded Health Plans

Communication Skills

Organizational Skills

Problem-Solving Skills

Education

Bachelor's degree or equivalent work experience

Tools

Microsoft Office Suite

Job description

Join to apply for the Case Manager I role at Allied Benefit Systems

Allied Benefit Systems provided pay range

This range is provided by Allied Benefit Systems. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$48,000.00/yr - $50,000.00/yr

Position Summary

The Enhanced Case Management Specialist position will have a full understanding of the Enhanced Case Management (ECM) suite of strategies and supports the Enhanced Care Advocate and ECM team. The Specialist will primarily focus on vendor, carrier, and Center for Medicare and Medicaid Services (CMS), and member communication.

Essential Functions

1. Identifying and communicating coverage options available to a member under various scenarios (i.e., member qualifying event, obtaining age 65, etc.).
2. Implement and coordinate with the member, client, Allied, and various vendor partners.
3. Communicate with CMS to obtain essential member information.
4. Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member set-up, and provide ongoing support.
5. Review clinicals, claims, and baseline case information for Behavioral, Wellness, and Specialty Prescription support needs and develop a plan with available resources.
6. Work closely with the Case Management team and Case Managers to obtain clinical information.
7. Assist in troubleshooting and resolving escalated issues.
8. Execute assorted weekly and monthly administrative tasks.
9. Act as the liaison between the client/broker/member and Allied Executives and Departments.
10. Identify and collaborate to improve internal processes within Enhanced Case Management and other departments.
11. Produce and analyze ad hoc reports when requested.
12. Provide training to clients and brokers as needed.

Education

• Bachelor’s degree or equivalent work experience required.

Experience & Skills

• At least 2 years of experience with Group Health Insurance and Self-Funded Health Plans.
• Excellent communication, interpersonal, and customer service skills.
• Strong organizational, time management, and problem-solving skills.
• Experience with Medicare, Medicaid, Case Management, and prescription drug benefits preferred.
• Experience in clinical or social work, hospital systems, or holding a Life and Health Insurance Producer License is a plus.
• Proficient in Microsoft Office Suite or related software.

Competencies

• Job Knowledge, Time Management, Accountability, Communication, Initiative, Customer Focus

Physical Demands

• Ability to sit for long periods and communicate via telephone.

Work Environment

• Remote

The company has reviewed this job description to ensure essential functions and duties are included. Additional functions may be assigned as deemed appropriate. Compensation includes a competitive benefits package and is contingent upon meeting role requirements and successful interview completion. Allied reserves the right to amend pay ranges and benefits at any time.