Position: Care Management Specialist

Compensation: $39/hr

Location: This is remote, visiting members (one in Chicago and one Rockford); training will require some onsite days

Job Type: 3-month W2 contract with the potential to be extended or converted to direct

BASIC FUNCTION:

• This position is responsible for discharge care coordination, episodic case management and pre-admission/post-discharge counseling for an acute condition.
• This position is responsible for handling duties in an independent manner and may assist other staff.
• Establish relationship with the member through the immediate post discharge follow-up period or until all short-term care needs are met.
• Provide education/local resource information and encourage member (self) education.
• Determine case complexity and refer to other internal departments as needed.

ESSENTIAL FUNCTIONS:

• Discharge care coordination, episodic case management and pre-admission/post discharge counseling and identification of alternate treatment options.
• Consult with physicians, providers, members, and other resources, as appropriate.
• Personalize outreach/engagement based upon attitudes/behaviors/risk assessment. Outreach to provider to coordinate the member's care or to notify of risks/new conditions.
• Reconcile, educate and monitor adherence to medication safety.
• Reinforce provider post-operative instructions for care, diet, activity level etc.
• Address barriers to keeping follow-up appointments with appropriate provider and assistance with appointment scheduling. f. Assistance finding a primary or specialist provider, a Blue Distinction Center or any needed coordination with Customer Service.
• Assist with getting to a provider if needed when all other options have been exhausted.
• Referral to other BCC programs, or external resources community-based organizations, transportation, home health etc.
• Provide on-site face to face intervention in select cases.
• Education and recommendations to resolve conditions and risks, and support for behavior change/ self-management.
• Collaborate with the provider and member when appropriate to develop alternate plans of care if needed.
• Assist members/providers to navigate the health care system. m. Assess cases for quality-of-care issues and refer cases to the QA/QI department for review and follow up.
• Perform Transition of Care services for all assigned lines of business.
• Determine case complexity and may refer to Case Management/Disease Management/Enterprise Lifestyle Management department personnel as necessary.
• Practice within the scope of licensure.
• Participate as preceptor for orientation of new employees.
• Maintain licensure and maintain and enhance knowledge for designated area of licensure and regulatory standards by attending seminars, training sessions, etc.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

REQUIREMENTS:

• Registered Nurse (RN) or Licensed Master Social Worker (LMSW) with current, active, unrestricted license in the state of operations (or reciprocity if applicable).
• 2 years clinical experience.
• 1 year health insurance/managed care experience.
• Knowledge of medical management policies and procedures.
• PC and database experience.
• Verbal and written communication skills.
• Customer service skills and interpersonal skills to discuss pre/post admission care with physicians, hospital staff and members.
• Ability and willingness to occasionally travel within assigned location. Possess transportation and current, valid driver's license for applicable state.