Nurse Case Manager II

SGS Consulting; Springfield (IL); Hybrid; USD 65,000 - 90,000; Full time

Job summary

SGS Consulting seeks a qualified healthcare professional for complex case management involving assessments of referred members in Illinois. The role requires interpreting benefit plans, determining appropriate services, and coordinating care with internal and external programs.

The ideal candidate holds RN, LCSW, or LCPC with an active IL license and is comfortable with up to 50–75% travel, working from home between visits. Strong organizational skills and independent work ethic are essential.

Qualifications

• RN, LCSW, or LCPC with current unrestricted IL state licensure.

Responsibilities

• Assess referred members' needs and eligibility and determine approach to case resolution.
• Interpret benefit plans and programs/services to ensure appropriate administration of benefits.
• Apply regulatory standards and company policies in managing benefits and coordinating care.
• Utilize case management and quality management processes in compliance with guidelines.

Skills

RN

LCSW

LCPC

Job description

Job Responsibilities:

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/servicesApplication and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefitsUtilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Skills:

RN, LCSW, or LCPC with current unrestricted state licensure in IL is requiredThe position will require travel to members' homes up to 50-75% travel. Must live near areas listed due to travel requirement and will work at home in between visits. We want someone who is organized, efficient, and can work independently.

Education/Experience:

RN, LCSW, or LCPC with current unrestricted IL state licensure REQUIRED