Enhanced Case Management Advocate

Allied Benefit Systems, Inc.; Illinois; Remote; USD 63,000 - 70,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to enhance member engagement and support. In this pivotal role, you will assist clients in navigating their benefit options, ensuring they understand the best pathways available for their healthcare needs. Your strong communication skills will be vital as you work directly with members and their families, guiding them through complex programs like Medicaid and Medicare. This position offers the chance to make a significant impact in the lives of individuals while working in a supportive remote environment. Join a team that values initiative and customer focus, and help shape the future of healthcare management.

Qualifications

• 3-5 years in social services roles required.
• Strong communication skills essential for member engagement.

Responsibilities

• Support members in understanding benefit options.
• Facilitate engagement with families for Enhanced Case Management.

Skills

Verbal Communication

Written Communication

Decision-Making

Time Management

Customer Focus

Education

Bachelor of Science Degree

BS in Social Work

Tools

Microsoft Office

Job description

Job Details

Job Location: Allied Benefit Systems - CHICAGO, IL

Position Type: Full Time

Salary Range: $63,000 - $70,000

Job Category: Medical Management

Description

POSITION SUMMARY

Support Allied’s Enhanced Case Management Services by communicating directly with identified plan members to assist them in understanding all benefit options available to them and/or their family. This may include options through the employer, alternative coverages (e.g., spouse’s coverage, government programs), and other means. Strong verbal and written communication skills are essential, along with decision-making skills.

ESSENTIAL FUNCTIONS

1. Identify individuals from our ASO Self-Funded and Co-Sourcing Partially Self-Funded Clients based on current medical conditions, future claim costs, and financial assessments for Enhanced Case Management evaluation, and identify strategic options.
2. Facilitate ongoing engagement with members and/or families under Enhanced Case Management to assess their participation prospects.
3. Produce and review financial analyses/assessments (contributions and out-of-pocket expenses under the Group Health Plan versus alternative options) with members and/or families to determine the best options.
4. Assist members and/or families in enrolling in CMS programs—Medicaid, Medicare—and other assistance programs (e.g., American Kidney Fund Grant) or coverage options (e.g., Exchange-Based Coverage).
5. Manage prescription drug vendor relationships, negotiate pricing, support member setup, and provide ongoing support.
6. Coordinate with Account Executive/Account Manager regarding cases with Designated Member Employer Groups.
7. Regularly strategize with VP, Risk, and the ECM Team to discuss case progress.
8. Document and track time spent on each Enhanced Case Management member.
9. Assist the Director, Account Services, in streamlining processes, workflows, and ensuring quality standards.
10. Perform other related duties as assigned.

Education

• Bachelor of Science Degree (minimum)
• BS in Social Work preferred

Experience and Skills

• 3-5 years minimum in social services roles
• Intermediate proficiency with Microsoft Office (Word, Excel, Access, PowerPoint)
• Strong written and verbal communication skills
• Preferred certifications: LMSW, LCSW, CCM (not required)

Position Competencies

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

Physical Demands

• This role involves long periods of sitting and working on a computer.

Work Environment

• Remote work setting

Note: This description covers essential functions and duties but is not exhaustive. Additional responsibilities may be assigned. Compensation includes a competitive benefits package, and pay ranges are subject to change at the company's discretion.