Case Manager I

Allied Benefit Systems, Inc.; Illinois; Remote; USD 48,000 - 50,000; Full time

Job summary

An established industry player is seeking an Enhanced Case Management Specialist to join its dynamic team. This role involves supporting the Enhanced Care Advocate and ECM team by effectively communicating with vendors, carriers, and members. You will play a crucial part in coordinating member care, negotiating with vendors, and analyzing clinical data to develop tailored support plans. If you excel in communication, problem-solving, and have a passion for improving healthcare outcomes, this opportunity offers a chance to make a significant impact while working in a supportive and collaborative environment.

Qualifications

• Bachelor's degree or equivalent work experience required.
• 2+ years of experience with Group Health Insurance and Self-Funded Health Plans.

Responsibilities

• Identify and communicate coverage options available to members.
• Facilitate and maintain prescription drug vendor relationships.
• Produce and analyze ad hoc reports as requested.

Skills

Group Health Insurance

Self-Funded Health Plans

Verbal Communication

Written Communication

Customer Service

Analytical Skills

Problem-Solving

Organizational Skills

Time Management

Education

Bachelor's Degree

Tools

Microsoft Office Suite

Job description

Job Details

Job Location: Allied Benefit Systems - CHICAGO, IL

Position Type: Full Time

Salary Range: $48000.00 - $50000.00 Salary

Job Category: Medical Management

Description

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

• Identify and communicate coverage options available to a member under various scenarios (e.g., member qualifying event, turning 65).
• Implement and coordinate with the member, client, Allied, and various vendor partners.
• Communicate with CMS to obtain essential member information.
• Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member setup, and provide ongoing support.
• Review clinicals, claims, and baseline case information for behavioral, wellness, and specialty prescription support needs, and develop plans with available resources.
• Work closely with the Case Management team and Case Managers to obtain clinical information.
• Assist in troubleshooting and resolving escalated issues.
• Execute weekly and monthly administrative tasks.
• Act as the liaison between the client/broker/member and Allied executives and departments.
• Troubleshoot, identify, and collaborate to improve internal processes within Enhanced Case Management and other Allied departments.
• Produce and analyze ad hoc reports as requested.
• 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 verbal and written communication skills.
• Strong interpersonal and customer service skills.
• Excellent organizational skills and attention to detail.
• Effective time management skills with a proven ability to meet deadlines.
• Ability to review information, assess problems, and propose solutions.
• Strong analytical and problem-solving skills.
• Experience with Medicare, Medicaid, Case Management, and prescription drug benefits preferred.
• Experience in clinical or social work positions is a plus.
• Experience working in a hospital system is a plus.
• Life and Health Insurance Producer License is preferred but not required.
• Proficient with 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