Maternity Case Manager (Fully Remote)

About the role

The Case Manager I will support the Enhanced Case Management (ECM) team by managing vendor, carrier, Center for Medicare and Medicaid Services (CMS), and member communications for case evaluation, referrals, and impact assessment.

Responsibilities

• Review clinical, claims, and baseline case information for health scenarios such as Behavioral, Wellness, Specialty Prescription, and Maternity.
• Develop strategic care plans to support members by connecting them with specialized vendor partners and Allied Care Clinicians.
• Implement care plans by coordinating with members, clients, Allied staff, and vendor partners.
• Collaborate with the Clinical Case Management team to obtain clinical information and present cases for troubleshooting escalated issues.
• Communicate with CMS to obtain essential member information.
• Facilitate and maintain prescription drug vendor relationships, negotiate pricing, manage member set-up, and provide ongoing support.
• Document casework impact to highlight cost savings and improved member health outcomes.
• Perform weekly and monthly administrative tasks.
• Act as a liaison between clients, brokers, members, and Allied Executives/Departments.
• Troubleshoot and optimize internal processes within ECM and Allied departments.
• Other duties as assigned.

Requirements

• Bachelor’s degree or equivalent work experience.
• 2 years of experience with Group Health Insurance and Self-Funded Health Plans.
• Excellent verbal and written communication skills.
• Strong interpersonal, customer service, organizational, and time management skills.
• Ability to review information, assess problems, and propose viable solutions.
• Strong analytical and problem-solving skills.
• Proficiency with Microsoft Office Suite or related software.

Preferred Qualifications

• Medicare, Medicaid, Case Management, and prescription drug benefit experience.
• Experience in a clinical or social work position.
• Experience working in a hospital system.
• Life and Health Insurance Producers License.

Skills

• Accountability
• Analytical Thinking
• Collaboration
• Communication
• Customer Focus
• Functional Expertise
• Initiative

Physical Demands

This is a standard desk role requiring extended sitting and computer work, with the ability to communicate via telephone.

Work Environment

Remote. The role requires a reliable internet connection with speeds of at least 100Mbps download/25Mbps upload through a cable broadband or fiber optic provider.

Benefits

• Medical, Dental, Vision, Life, and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• Employee Assistance Program (EAP)
• Technology Stipend