Case Manager in Springfield, IL at Pionear

Date Posted: 6/11/2019

Job Snapshot

Job Description

  • Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes.
  • Works with members to create and implement an integrated collaborative plan of care.
  • Coordinates and monitors member's progress and services to ensure consistent cost effective care that complies with policy and all state and federal regulations and guidelines.

Essential Functions: •

  • Provides case management services to members with chronic or complex conditions including: o Proactively identifies members that may qualify for potential case management services.
  • Conducts assessment of member needs by collecting in-depth information from information system, the member, member's family/caregiver, hospital staff, physicians and other providers.
  • Identifies, assesses and manages members per established criteria.
  • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
  • Performs ongoing monitoring of the plan of care to evaluate effectiveness.
  • Documents care plan progress in  information system.
  • Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
  • Measures the effectiveness of interventions to determine case management outcomes. •
  • Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for  members. •
  • Conducts face to face or home visits as required. •
  • Maintains department productivity and quality measures. • Manages and completes assigned work plan objectives and projects in a timely manner. • Demonstrates dependability and reliability. •
  • Maintains effective team member relations. •
  • Adheres to all documentation guidelines.

Job Requirements

Knowledge/Skills/Abilities: •

  • Demonstrated ability to communicate, problem solve, and work effectively with people. •
  • Excellent organizational skill with the ability to manage multiple priorities. •
  • Work independently and handle multiple projects simultaneously. •
  • Strong analytical skills. •
  • Knowledge of ICD-9, CPT coding and HCPC. •
  • SSI, Coordination of benefits, and Third Party Liability programs and integration. •
  • Familiarity with NCQA standards, state/federal regulations and measurement techniques. •

Required Education:

  • Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Experience:

  • 0-2 years of clinical experience with case management experience.

Required Licensure/Certification:

  • Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.
  • Must have valid driver's license with good driving record and be able to drive locally.

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