Remote Chronic Illness Case Manager

This role supports 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 clinicals, 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 gather 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 or departments.
• Troubleshoot and optimize internal processes within ECM and Allied departments.
• Perform 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 and customer service skills.
• Excellent organizational skills and attention to detail.
• Proven ability to meet deadlines and manage time effectively.
• 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

• Standard desk role requiring extended sitting and computer work.
• Ability to communicate via telephone.

Work Environment

This is a remote role. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload.

Benefits

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