[Hiring] Case Manager I @Allied Benefit Systems

Role Description

The Case Manager I 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 for purposes of case evaluation, appropriate referral making and determining impacts.

Essential Functions

• Review clinicals, claims and baseline case information for health scenarios such as Behavioral, Wellness, and Specialty Prescription, Maternity etc.
• Develop strategic, initiative care plans to support members with varying health scenarios by connecting them to specialized vendor partners and Allied Care Clinicians that can facilitate the needs of the member.
• Implement the care plan by coordinating with the member, client, Allied staff and/or the various specialized vendor partners.
• Work closely with the Clinical Case Management team and other Case Managers to obtain clinical information needed to support the care plan.
• Communicate with (CMS) to obtain essential member information.
• Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member set-up, and provide on-going support.
• Document the impact of the casework to highlight cost savings and the improvement of member health outcomes as a result of implementing a plan of care.
• Perform assorted weekly and monthly administrative tasks.
• Act as the liaison between the client/broker/member and Allied Executives and Various Departments.
• Troubleshoot, identify, and collaborate to optimize internal processes within Enhanced Case Management and the various Allied departments.
• Other duties as assigned.

Qualifications

• Bachelor’s degree or equivalent work experience required.
• 2 years of experience with Group Health Insurance and Self-Funded Health Plans 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 preferred.
• Experience in a clinical or social work position a plus.
• Experience working in a hospital system a plus.
• Life and Health Insurance Producers License is preferred, but not required.
• Proficient with Microsoft Office Suite or related software.

Requirements

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

Physical Demands

• Ability to sit for long periods of time.
• Ability to communicate via telephone.

Work Environment

• Remote

Benefits

• Medical, Dental, Vision, Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend