Position: Care Management Specialist
Location: Remote (Chicago, IL)
Employment Type: Full-Time Contract
Pay: $38 per hour
Description: We are seeking a dedicated and self-motivated professional to join our team as a Care Management Specialist. This role is responsible for managing discharge planning, episodic case management, and pre-admission/post-discharge counseling for patients with acute conditions. The ideal candidate will work independently while collaborating with other staff as needed to ensure seamless care transitions and optimal patient outcomes.
Responsibilities:
- Coordinate discharge care, episodic case management, and counseling for pre-admission and post-discharge needs
- Identify alternate treatment options and consult with physicians, coordinators, and facility discharge planners
- Educate and counsel members to reduce re-admissions and emergency room visits
- Support members through the transition of care process by:
- Assessing, planning, implementing, coordinating, and evaluating care options
- Personalizing outreach based on risk assessments and member behavior
- Coordinating care with providers and notifying them of risks or new conditions
- Educating on medication safety and monitoring adherence
- Reinforcing post-operative instructions and addressing barriers to follow-up care
- Assisting with provider selection, appointment scheduling, and transportation
- Referring to internal programs and community-based resources
- Providing on-site, face-to-face interventions when needed
- Supporting behavior change and self-management
- Collaborating with providers and members to develop alternate care plans
- Navigating the healthcare system and identifying quality of care issues
- Performing Transition of Care services across assigned lines of business
- Referring complex cases to appropriate internal departments
- Additional Duties:
- Practice within the scope of licensure
- Serve as a preceptor for new employee orientation
- Maintain licensure and stay current with regulatory standards through training
- Communicate professionally with coworkers, management, and customers
- Comply with HIPAA, Diversity Principles, Corporate Integrity, and other policies
- Maintain confidentiality and report developments to management
- Perform special projects as assigned
Requirements:
- Registered Nurse (RN) or Licensed Master Social Worker (LMSW) with active, unrestricted license in Illinois (or reciprocity if applicable)
- Minimum 2 years of clinical experience
- At least 1 year of experience in health insurance or managed care
- Knowledge of medical management policies and procedures
- Proficiency in PC and database systems
- Strong verbal and written communication skills
- Excellent customer service and interpersonal skills
- Willingness and ability to travel occasionally within assigned location
- Valid driver’s license and reliable transportation
- Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management.