Healthcare Case Manager I

PME is looking for a Healthcare Case Manager I (RN, LCSW, LSW) experienced in Case Management to be responsible for health care management and coordination of healthcare members. MUST reside within proximity of Bureau and Dekalb counties. The position will require field visits 3 days a week and rest is from home. Schedule M-F 8:00am-5:00pm CST.
 

• Works with members to create and implement an integrated collaborative plan of care.
• Coordinates and monitors Healthcare members’ progress and services.
• Provides case management services to members with chronic or complex conditions.
• Proactively identifies members that may qualify for potential case management services.
• Conducts assessment of member needs by collecting in-depth information from healthcare information system, the member, member’s family/caregiver, hospital staff, physicians, and other providers.
• Managing health and waiver services of our membership within the health plan.
• Providing education to members on health benefits, working with various providers in home care to be sure member is getting all the hours they are authorized for.
• Working with Illinois Dept. of Aging agencies and Dept. of Rehab Services counselors.

Requirements

• Healthcare Case Management experience
• RN, LPN or bachelors in social service or related field.
• Familiarity with NCQA standards, state/federal regulations, and measurement techniques. In depth knowledge of CCA and/or other Case Management tools.

Required Experience

• 0-2 years of clinical experience with case management experience.

• Active, unrestricted State Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.
• Must have a valid driver’s license with good driving record and be able to drive locally if required.

PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.