Remote Case Manager, Clinical Review & Care Optimization

Position Summary The 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. Essential Functions

• Review clinicals, claims and baseline case information for health scenarios such as Behavioral, Wellness, and Specialty Prescription, Maternity etc.
• 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.
• Implement the care plan by coordinating with the member, client, Allied staff and/or the various specialized vendor partners.
• 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.
• Communicate with (CMS) to obtain essential member information.
• Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member set-up, and provide on-going support.
• 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.
• Perform assorted weekly and monthly administrative tasks.
• Act as the liaison between the client/broker/member and Allied Executives and Various Departments.
• Troubleshoot, identify, and collaborate to optimize internal processes within Enhanced Case Management and the various Allied departments.
• Other duties as assigned.

EDUCATION

• Bachelor’s degree or equivalent work experience required.

Experience And Skills

• 2 years of experience with Group Health Insurance and Self-Funded Health Plans required.
• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Ability to review information, assess the problem, and propose viable solutions.
• Strong analytical and problem-solving skills.
• Medicare, Medicaid, Case Management and prescription drug benefit experience preferred.
• Experience in a clinical or social work position a plus.
• Experience working in a hospital system a plus.
• Life and Health Insurance Producers License is preferred, but not required.
• Proficient with Microsoft Office Suite or related software.

POSITION COMPETENCIES

• Accountability
• Analytical Thinking
• Collaboration
• Communication
• Customer Focus
• Functional Expertise
• Initiative

PHYSICAL DEMANDS

• This is a standard desk role requiring extended sitting and computer work.
• Ability to communicate via telephone.

WORK ENVIRONMENT

• Remote

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. 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. Compensation is not limited to base salary. 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. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. 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. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.