Case Manager I

Position Overview

The Enhanced Case Management Specialist position requires a comprehensive understanding of the Enhanced Case Management (ECM) suite of strategies. The role supports the Enhanced Care Advocate and ECM team by focusing on vendor, carrier, CMS, and member communication.

Key Responsibilities

• Identifying and communicating coverage options available to a member under various scenarios (e.g. qualifying event, reaching age 65).
• Implementing and coordinating with the member, client, Allied, and various vendor partners.
• Communicating with CMS to obtain essential member information.
• Facilitating and maintaining prescription drug vendor relationships, negotiating pricing as needed, managing member set-up, and providing ongoing support.
• Reviewing clinicals, claims, and baseline case information for Behavioral, Wellness, and Specialty Prescription support needs and mapping a plan with the available resources.
• Collaborating with the Case Management team and Case Managers to obtain clinical information.
• Assisting in troubleshooting and resolving escalated issues.
• Executing assorted weekly and monthly administrative tasks.
• Acting as the liaison between the client/broker/member and Allied Executives and various departments.
• Troubleshooting, identifying, and collaborating to improve internal processes within Enhanced Case Management and Allied departments.
• Producing and analyzing ad hoc reports when requested.
• Providing training to clients and brokers as needed.

Required Qualifications

• Bachelor’s degree or equivalent work experience.
• 2 years of experience with Group Health Insurance and Self-Funded Health Plans.
• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Strong organizational skills with keen attention to detail.
• Effective time management and proven ability to meet deadlines.
• Ability to review information, assess problems, and propose viable solutions.
• Proficiency with Microsoft Office Suite or related software.

Preferred Qualifications

• Experience with Medicare, Medicaid, Case Management, and prescription drug benefits.
• Experience in a clinical or social work position.
• Experience working in a hospital system.
• Life and Health Insurance Producers License (preferred but not required).

Benefits & Perks

• Compensation is not limited to base salary.
• Competitive Total Rewards featuring a comprehensive benefit package offering Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
• Remote work environment.