Analyst, Case Manager

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

As a Analyst, Case Manager, you will facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Responsibilities

• Evaluate members' needs and eligibility, and recommend approaches to case resolution and/or meeting needs by assessing their benefit plans and available internal and external programs/services.
• Identify high-risk factors and service needs that may impact member outcomes and care planning components, making referrals to clinical case management or crisis intervention as needed.
• Coordinate and implement assigned care plan activities, monitoring care plan progress.
• Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers to meeting goals and objectives.
• Present cases at case conferences to obtain multidisciplinary reviews for optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure suitable options and services necessary to meet members' benefits and/or healthcare needs.
• Employ influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes for optimum health.
• Provide coaching, information, and support to empower members to make ongoing independent medical and/or healthy lifestyle choices.
• Help members actively and knowledgeably participate with their providers in healthcare decision-making.
• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Reside in St Clair County, IL or surrounding areas.
• Willing and able to travel 50-75% of the time to meet members face-to-face.
• Minimum 2 years of experience in behavioral health, social services, or human services field.
• Minimum 2 years of case management experience.

Preferred Qualifications

• Discharge planning experience.
• Managed care experience.
• Microsoft Office experience.

Education

• Bachelor's degree or non-licensed master's level clinician required, with either degree being in behavioral health or human services (psychology, social work, marriage and family therapy, counseling).

Anticipated Weekly Hours

• 40 hours per week.

Time Type

• Full-time.

Pay Range

• $21.10 - $44.99 per hour.

Benefits

• Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.