Hiring for Field Case Manager in St. Clair County, IL

Job ID: 26-129287
Job title:  Healthcare Consultant I
Position type: Contract/ fulltime role
Location: St. Clair County, IL
Work type: Hybrid (travel up to 75% of their time to meet with members face to face, rest work from home)
Est. pay range: $30.00/hour – $34.13/Hour on W2 (USD) (all inclusive)
Schedule: Monday - Friday 8a-5p

Description:
Add city state and zip to top of resume Must reside in the state of Illinois in St Clair County, Illinois area • Valid Illinois Driver’s license • Willing and able to travel up to 75% of their time to meet with members face to face • Reliable Transportation required, eligible for mileage reimbursement as per company policy. • Minimum of two (2) years of case management experience • Microsoft Office and electronic health record experience This Analyst, Case Management Field position is with Client’s Long-Term Services & Supports (LTSS) team and is a field-based position out of the xxxx area of Illinois. The requirements is for candidates to travel 50-75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.

Position Summary:
This Analyst, Case Management Field position is with Client’s Long Term Services & Supports (LTSS) team and is a field-based position out of the St.Clair County area of Illinois. The requirements is for candidates to travel 50-75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.

Duties:
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 to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services. o Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. o Coordinates and implements assigned care plan activities and monitors care plan progress. • Enhancement of Medical Appropriateness and Quality of Care: o 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. o Identifies and escalates quality of care issues through established channels. o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs. o Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. o Helps member actively and knowledgeably participate with their provider in healthcare decision-making. • Monitoring, Evaluation and Documentation of Care: o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.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 to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services. o Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. o Coordinates and implements assigned care plan activities and monitors care plan progress. • Enhancement of Medical Appropriateness and Quality of Care: o 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. o Identifies and escalates quality of care issues through established channels. o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs. o Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. o Helps member actively and knowledgeably participate with their provider in healthcare decision-making. • Monitoring, Evaluation and Documentation of Care: o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Experience: Must reside in the state of Illinois in St. Clair County IL area • Valid Illinois Driver’s license • Willing and able to travel up to 75% of their time to meet with members face to face • Reliable Transportation required, eligible for mileage reimbursement as per company policy. • 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

Education: 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)