Enhanced Care Case Manager (Health Plans) - Remote

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    "jobTitle": "Enhanced Care Case Manager (Health Plans) - Remote",
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    "description": "<p>&nbsp;</p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><strong><span style=\"font-family:Arial,sans-serif\">POSITION SUMMARY:&nbsp;</span></strong></span></p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">The&nbsp;</span></span>Enhanced Care Case Manager-Health Plans<span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">&nbsp;(Case Manager I) position will have a full understanding of the Enhanced Case Management (ECM) suite of strategies and supports the Enhanced Care Advocate and ECM team. The Specialist will primarily focus on vendor, carrier, and Center for Medicare and Medicaid Services (CMS), and member communication for purposes of case evaluation, appropriate referral making and determining impacts.&nbsp;</span></span></p>\n\n<p>&nbsp;</p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><strong><span style=\"font-family:Arial,sans-serif\">ESSENTIAL FUNCTIONS:&nbsp;</span></strong></span></p>\n\n<ul>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Review clinicals, claims and baseline case information for health scenarios such as Behavioral, Wellness, and Specialty Prescription, Maternity etc.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Develop strategic, initiative care plans to support members with varying health scenarios by connecting them to specialized vendor partners and Allied Care Clinicians that can facilitate the needs of the member.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Implement the care plan by coordinating with the member, client, Allied staff and/or the various specialized vendor partners.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Work closely with the Clinical Case Management team and other Case Managers to obtain clinical information needed to support the care plan. This includes case presentation when needed to discuss collaboratively to identify and troubleshoot escalated issues within case work.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Communicate with (CMS) to obtain essential member information.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member set-up, and provide on-going support.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Document the impact of the casework to highlight cost savings and the improvement of member health outcomes as a result of implanting a plan of care.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Perform assorted weekly and monthly administrative tasks.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Act as the liaison between the client/broker/member and Allied Executives and Various Departments.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Troubleshoot, identify, and collaborate to optimize internal processes within Enhanced Case Management and the various Allied departments.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Other duties as assigned.</span></span></span></li>\n</ul>\n\n<p style=\"margin-left:24px\">&nbsp;</p>\n\n<p style=\"margin-left:24px\">&nbsp;</p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><strong><span style=\"font-family:Arial,sans-serif\">EDUCATION&nbsp;</span></strong></span></p>\n\n<ul>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><em><span style=\"font-family:Arial,sans-serif\">Bachelor&rsquo;s degree or equivalent work experience required.</span></em></span></li>\n</ul>\n\n<p>&nbsp;</p>\n\n<p>&nbsp;</p>\n\n<p>&nbsp;</p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><strong><span style=\"font-family:Arial,sans-serif\">EXPERIENCE AND SKILLS&nbsp;</span></strong></span></p>\n\n<ul>\n\t<li><span style=\"background-color:#ffffff\"><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">2 years of experience with Group Health Insurance and Self-Funded Health Plans required.</span></span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><em><span style=\"font-family:Arial,sans-serif\">Excellent verbal and written communication skills.</span></em></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><em><span style=\"font-family:Arial,sans-serif\">Excellent interpersonal and customer service skills.</span></em></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><em><span style=\"font-family:Arial,sans-serif\">Excellent organizational skills and attention to detail.</span></em></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><em><span style=\"font-family:Arial,sans-serif\">Excellent time management skills with a proven ability to meet deadlines.</span></em></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Ability to review information, assess the problem, and propose viable solutions.</span></span></li>\n\t<li><span style=\"background-color:#ffffff\"><span style=\"font-family:'Times New Roman',serif\"><em><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Strong analytical and problem-solving skills.</span></span></em>&nbsp;</span></span></li>\n\t<li><span style=\"background-color:#ffffff\"><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Medicare, Medicaid, Case Management and prescription drug benefit experience preferred.&nbsp;</span></span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Experience in a clinical or social work position a plus.</span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Experience working in a hospital system a plus.</span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Life and Health Insurance Producers License is preferred, but not required.</span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><em><span style=\"font-family:Arial,sans-serif\">Proficient with Microsoft Office Suite or related software.</span></em></span></li>\n</ul>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><strong><span style=\"font-family:Arial,sans-serif\">POSITION COMPETENCIES</span></strong></span></p>\n\n<ul>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Accountability</span></span></span></li>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Analytical Thinking</span></span></span></li>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Collaboration</span></span></span></li>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Communication</span></span></span></li>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Customer Focus</span></span></span></li>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Functional Expertise</span></span></span></li>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">Initiative</span></span></span></li>\n</ul>\n\n<p>&nbsp;</p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><strong><span style=\"font-family:Arial,sans-serif\">PHYSICAL DEMANDS</span></strong></span></p>\n\n<ul>\n\t<li><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-family:Arial,sans-serif\"><span style=\"color:#000000\">This is a standard desk role requiring extended sitting and computer work.</span></span></span></li>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Ability to communicate via telephone.</span></span></li>\n</ul>\n\n<p>&nbsp;</p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><strong><span style=\"font-family:Arial,sans-serif\">WORK ENVIRONMENT</span></strong></span></p>\n\n<ul>\n\t<li><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Remote</span></span></li>\n</ul>\n\n<p>&nbsp;</p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. 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. Reliable internet service is essential for staying connected and productive</span><span style=\"font-family:Calibri,sans-serif\">.</span></span></p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.</span></span></p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Compensation is not limited to base salary.&nbsp; Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.</span></span></p>\n\n<p><span style=\"font-family:'Times New Roman',serif\"><span style=\"font-family:Arial,sans-serif\">Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.&nbsp; All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.&nbsp; It is at the Company&#39;s discretion to determine what pay is provided to a candidate within the range associated with the role.</span></span></p>\n",
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