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Case Manager I

Integrated Resources, Inc Chicago Contractor
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Job Title: Case Manager
Duration: 6 Months
Location: Chicago, IL
 
Job Description:
  • Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes.
  • Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitor member’s progress and services to ensure consistent cost-effective care that complies with policy and all state and federal regulations and guidelines.
 
Essential Functions:
  • Provides case management services to members with chronic or complex conditions including:
  • Proactively identifies members that may qualify for potential case management services.
  • Conducts assessment of member needs by collecting in-depth information from system, the member, member’s family/caregiver, hospital staff, physicians and other providers.
  • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
  • Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
  • Measures the effectiveness of interventions to determine case management outcomes.
  • Promotes integration of services for members including behavioral health and long-term care to enhance the continuity of care for members.
  • Maintains effective team member relations.
  • Participates in Interdisciplinary Care Team (ICT) meetings.
 
Knowledge/Skills/Abilities:
  • Demonstrated ability to communicate, problem solve, and work effectively with people. 
  • Strong analytical skills.
  • Knowledge of applicable state, and federal regulations.
  • Knowledge of ICD-9, CPT coding and HCPC.
  • Familiarity with NCQA standards, state/federal regulations and measurement techniques.
  • In depth knowledge of CCA and/or other Case Management tools. 
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
 
Required Education:
  • Bachelor’s degree in Nursing or master’s degree in social work, or Health Education.
  • 0-2 years of clinical experience with case management experience.
 

Recommended skills

Social Work
Nursing
Case Management
Hospitals
Long Term Care
Caregiving
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Job ID: 19-12032

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