Nurse Case Manager II

Location & Work Arrangement:

• Candidates can live anywhere in IL.
• This is a hybrid role; they will be mostly WFH with some member visits in the area they live as needed.

Job Summary:

• The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
• Requires RN, LCSW, or LCPC with unrestricted active license in IL.

Duties:

• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
• Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Licensure Requirement:

• RN, LCSW, or LCPC with current unrestricted IL state licensure REQUIRED.

Experience:

• Minimum 3-5 years clinical practical experience required.
• Minimum 2-3 years Care Management, discharge planning and/or home health care coordination experience preferred.

Skills & Competencies:

• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently.
• Effective computer skills including navigating multiple systems and keyboarding.
• Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications.