Maternity Case Manager - Remote Care & Vendor Liaison

Allied Benefit Systems; Chicago (IL); Remote; USD 55,000 - 75,000; Full time

Job summary

Allied Benefit Systems is seeking a Case Manager I in a remote capacity to support Enhanced Case Management initiatives. You will review clinicals and claims, develop care plans, and coordinate with vendor partners to meet member needs.

The role focuses on CMS communications, referral decisions, and evaluating impacts on costs and outcomes while maintaining strong documentation and monthly admin tasks. A bachelor’s degree or equivalent experience is required.

Qualifications

• Bachelor’s degree or equivalent work experience is required.
• 2 years of experience with Group Health Insurance and Self-Funded Health Plans is required.
• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Ability to review information, assess the problem, and propose viable solutions.
• Strong analytical and problem-solving skills.
• Medicare, Medicaid, Case Management and prescription drug benefit experience is preferred.
• Experience in a clinical or social work position is a plus.
• Experience working in a hospital system is a plus.
• Life and Health Insurance Producers License is preferred, but not required.
• Proficient with Microsoft Office Suite or related software.

Responsibilities

• Review clinicals, claims and baseline case information for health scenarios.
• Develop strategic care plans and connect members to specialized vendor partners.
• Coordinate plan implementation with members, clients and Allied staff.
• Collaborate with Clinical Case Management to obtain necessary information.
• Communicate with CMS to obtain member information.
• Manage vendor relationships and pricing for prescriptions.
• Document case impact and health outcomes.
• Perform weekly and monthly administrative tasks.
• Serve as liaison between client/broker/member and Allied Executives.
• Troubleshoot and optimize internal processes within Enhanced Case Management.

Skills

Group Health Insurance

Verbal Communication

Written Communication

Interpersonal Skills

Customer Service

Time Management

Analytical Thinking

Problem Solving

Microsoft Office

Education

Bachelor's degree or equivalent work experience

Tools

Microsoft Office Suite

Job description

Allied Benefit Systems is seeking a Case Manager I in a remote capacity to support Enhanced Case Management initiatives. You will review clinicals and claims, develop care plans, and coordinate with vendor partners to meet member needs.

The role focuses on CMS communications, referral decisions, and evaluating impacts on costs and outcomes while maintaining strong documentation and monthly admin tasks. A bachelor’s degree or equivalent experience is required.