Job Description
Job Overview:We are seeking a dedicated and compassionate Clinical Case Manager to join our Value-Based Care Services team. This role is ideal for an Illinois-licensed LCSW, LCPC, or LPC who is passionate about enhancing patient care, improving health outcomes, and assisting members in navigating the healthcare system. As a key part of the healthcare team, you will engage in telephonic outreach, case management, and support members in achieving their healthcare-related goals.
Key Responsibilities:
Analyze and assess member eligibility for the Population Health Management Program through data collection and review.
Coordinate and provide member-centric care that is timely, effective, equitable, and safe within the HMO framework.
Manage case assignments, including outreach, documentation, ongoing monitoring, and case closure.
Maintain accurate and timely records while collaborating with internal teams and external stakeholders.
Support members in overcoming barriers to care, addressing social determinants of health, and guiding them toward wellness and autonomy.
Educate members on navigating the healthcare system and advocate for quality, cost-effective interventions and outcomes.
Contribute to operational and administrative tasks to ensure the highest level of service and compliance.
Maintain confidentiality and uphold regulatory standards related to medical records, data security, and compliance requirements.
Participate in Quality Management and Utilization Management Committee meetings, including material preparation, reporting, and follow-up.
Engage in professional development activities to stay current with case management standards and industry best practices.
May require participation in an off-hour/weekend on-call rotation, if applicable.
Perform other duties as assigned based on evolving program needs.
Qualifications:
Active Illinois LCSW, LCPC, or LPC license.
Minimum of five years of experience in healthcare settings or a Managed Care Organization.
Strong understanding of case management principles, healthcare management, and reimbursement processes.
Experience with motivational interviewing and member engagement strategies.
Excellent clinical judgment and strong verbal and written communication skills.
Highly organized with strong problem-solving and time-management abilities.
Ability to adapt to a fast-paced environment and changing business needs.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PDF) and experience working with electronic medical records (EMRs).
Ability to work independently in a remote setting while effectively managing multiple tasks.
Secure home internet connection with backup options and a private home office setup to ensure security and confidentiality.
Compensation & Schedule:
Salary: $70,000 per year, paid bi-weekly.
Flexible daytime scheduling available (Monday through Friday, between 6 AM and 6 PM CT), with an option for four 10-hour shifts after successful orientation.
Benefits & Perks:
Fully Remote Work: Enjoy the flexibility of working from home without the daily commute.
Comprehensive Health Coverage: Medical, dental, and vision plans to keep you and your family covered.
Retirement Savings: 401(k) plan with a 3% employer match to support your future financial goals.
Life & Disability Insurance: Essential coverage for peace of mind, with additional voluntary options available.
Employee Assistance Program (EAP): Support during challenging times.
Flexible Time Off (FTO): Encourages work-life balance tailored to your personal needs.
Paid Parental Leave: Support for growing families.
Professional Growth & Development: Access to learning resources and career advancement opportunities.
Equal Opportunity Employment Commitment:We are committed to fostering a diverse, inclusive, and equitable workplace. Employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification. We are dedicated to providing an inclusive environment where every employee feels valued and respected.
Data Privacy & Security:This role requires strict adherence to security policies to protect patient and company data, including compliance with HIPAA and other applicable regulations. Employees must follow best practices for safeguarding personal health information (PHI) and personally identifiable information (PII).
Technical Requirements for Remote Work:
Employer-provided equipment to support your role.
Reliable home internet with a minimum speed of 50 Mbps download and 10 Mbps upload to ensure smooth virtual communication.
Ability to participate in video calls and access internal systems securely.
If you're passionate about making a difference in patient care and improving healthcare access, we'd love to hear from you!
Employment Type: Full-Time
Salary: $ 70,000.00 Per Year
Job Tags
Full time, Remote job, Home office, Flexible hours, Shift work, Weekend work, Monday to Friday,