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Case Manager in Oak Brook, IL at Pionear

Date Posted: 3/10/2018

Job Snapshot

Job Description

Pionear Recruiting is currenlty looking for a Case Manager I for one of our biggest healthcare clients. This is an excellent opportunity to get your foot in the door. 
Responsible for health care management and coordination of clients 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 client member’s progress and services to ensure consistent cost effective care that complies with client policy and all state and federal regulations and guidelines.
Essential Functions:
Provides case management services to members with chronic or complex conditions including:

  • Proactively identifies members that may qualify for potential case management services

  • Conducts assessment of member needs by collecting in-depth information from Molina’s 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 Molina’s 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 Molina 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

Attends regular staff meetings

Participates in Interdisciplinary Care Team (ICT) meetings

Assists orientation and mentoring of new team members as appropriate

Maintains professional relationships with provider community and internal and external customers

Conducts self in a professional manner at all times

Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct

Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth

Complies with required workplace safety standards.

Job Requirements


  • 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 applicable state, and federal regulations

  • 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

  • In depth knowledge of CCA and/or other Case Management tools

  • Ability to take initiative and see tasks to completion

  • Computer skills and experience with Microsoft Office Products

  • Excellent verbal and written communication skills

  • Ability to abide by Molina’s policies

  • Able to maintain regular attendance based upon agreed schedule

  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA

  • Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers

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. A combination of experience and education will be considered in lieu of LCSW or APSW. Must have valid driver’s license with good driving record and be able to drive locally.
Pionear is an equal opportunity employer