Case Management Analyst - Field in Franklin County IL or Surrounding Area
Core
Facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education through care management tools and resources.
Role type
Case Management Analyst (Field)
Builds
Care plans and member support services
Domain
Health insurance / Managed care
Required skills
Care management, Medical appropriateness evaluation, Quality of care monitoring, Negotiation, Motivational interviewing, Coaching, Documentation compliance
Preferred skills
Discharge planning, Managed Care experience
Technologies
Microsoft Office, Electronic health records
Responsibilities
Conduct comprehensive evaluation of referred member's needs and eligibility; Identify high risk factors and service needs; Coordinate and implement assigned care plan activities; Consult with case managers and Medical Directors to overcome barriers; Escalate quality of care issues; Utilize negotiation skills to secure appropriate options; Provide coaching to empower members; Monitor care plan progress in compliance with regulatory guidelines.
Seniority
Mid-level, hands-on IC