IL-LTSS Telephonic Case Manager

Core Responsibilities

• Complete comprehensive telephonic assessments for members receiving or applying for LTSS services
• Develop individualized care plans addressing medical, behavioral health, and social support needs
• Carefully coordinate LTSS and clinical services with providers, specialists, and community-based organizations
• Facilitate continuity of care following hospital discharge and other care transitions
• Conduct ongoing outreach to monitor progress, reassess needs, and update care plans as needed
• Coordinate LTSS and RPM applications and documentation requirements in partnership with the realignment team
• Partner with interdisciplinary teams to support eligibility reviews and service planning
• Review clinical documentation and submit required information to support LTSS determinations
• Carefully coordinate waiver services and referrals to community-based programs to meet member needs
• Support implementation and optimization of RPM programs to improve outcomes and reduce avoidable utilization
• Train the Feet on the Street Team on RPM device setup, unboxing, and basic troubleshooting
• Document assessments, outreach, care plans, and interventions accurately in the electronic health record (EHR)
• Identify and help close HEDIS care gaps and other quality performance measures
• Participate in quality improvement activities to strengthen care coordination outcomes
• Collaborate with physicians, nurses, social workers, and other care team members to coordinate care
• Align services and resources across medical, behavioral health, and social needs
• Communicate member priorities, barriers, and care plan updates to the interdisciplinary team
• Promote integrated care coordination across LTSS, medical management, and RPM services
• Contribute to the development and maintenance of policies, procedures, and workflows for case management programs
• Identify opportunities to streamline care coordination, improve member experience, reduce avoidable utilization, and advance value-based care goals
• Participate in continuous improvement initiatives aligned with organizational goals and quality performance

Qualifications and Education

• Active multistate Registered Nurse (RN) license required
• CCM certification preferred
• Minimum 2+ years of experience in care management, case management, or population health
• Experience supporting Medicaid populations or complex care environments preferred
• Knowledge of Long-Term Services and Supports (LTSS) programs
• Experience using electronic health record (EHR) systems
• Ability to manage complex caseloads in a remote work environment
• Strong communication and care coordination skills