As a Case Management Coordinator, you will facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education through care management tools and resources.

Travel Requirements 75% travel required in Franklin County (IL) and surrounding counties.

Evaluation of Members

• Conduct comprehensive evaluations of referred members' needs and eligibility using care management tools and data review.
• Recommend approaches to case resolution and meet needs by evaluating members' benefit plans and available internal and external programs/services.
• Identify high-risk factors and service needs that impact member outcomes and care planning.
• Coordinate and implement assigned care plan activities and monitor progress.

Enhancement of Medical Appropriateness and Quality of Care

• Consult with case managers, supervisors, Medical Directors, and health programs to overcome barriers to meeting goals.
• Present cases at case conferences for multidisciplinary review to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet members' benefits and healthcare needs.
• Use influencing and motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes.
• Provide coaching, information, and support to empower members to make ongoing independent medical and healthy lifestyle choices.
• Help members actively participate with their providers in healthcare decision-making.

Monitoring, Evaluation, and Documentation of Care

• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.

Required Qualifications

• Reside in Illinois, specifically in Franklin County or surrounding areas.
• Valid Illinois Driver's license.
• Reliable transportation and willingness to travel up to 75% of the time.
• Minimum of two years of case management experience.
• Experience with Microsoft Office and electronic health records.

Preferred Qualifications

• Case management and discharge planning experience.
• Managed Care experience.
• Microsoft Office experience.

Education

• Bachelor's degree or non-licensed individual's master's degree in a human-services field.

Anticipated Weekly Hours 40

Time Type Full-time

Pay Range $21.10 - $44.99

Benefits Eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs.

Job Data by YubHub.