Field Case Management Analyst

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. 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.

Our Client, a Retail Pharmacy company, is looking for a Field Case Management Analyst for their St Clair County, IL 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 to case 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 to clinical 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:

• 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)

 
Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities