Our Client, a Retail Pharmacy company, is looking for a Field Case Management Analyst for their West side of Chicago/Downtown(60607, 60608, 60612, 60622, 60623, 60624, 60639, 60642, 60644, 60647, 60651) area of Illinois location.
Responsibilities:
Evaluation of Members:
Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach tcase resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.
Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral tclinical case management or crisis intervention as appropriate.
Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care:
Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
Monitoring, Evaluation and Documentation of Care:
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Requirements:
Minimum of two (2) years of case management experience
Microsoft Office and electronic health record experience
Preferred Qualifications
Case management and discharge planning experience
Managed Care experience
Microsoft Office experience
Experience working with HIV and AIDS population
Multi-lingual language proficiency
Individual with a bachelor’s degree or a non-licensed individual with a master’s degree, with either degree being in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling)