Case Manager I

@ Allied Benefit Systems

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, CMS, and member communication for case evaluation, appropriate referral making and determining impacts.

Essential Functions

• Review clinicals, claims, and baseline case information for various health scenarios.
• Develop strategic care plans and connect members with specialized vendor partners.
• Coordinate with members, clients, Allied staff and specialized vendors to implement care plans.
• Collaborate with Clinical Case Management team for clinical information and case escalation.
• Communicate with CMS to obtain essential member details.
• Manage prescription vendor relationships, negotiate pricing, and support member setup.
• Document casework impact to highlight cost savings and improved member outcomes.
• Perform weekly and monthly administrative tasks and act as a liaison between stakeholders.
• Troubleshoot and optimize internal processes across departments.

Education & Experience

Bachelor’s degree or equivalent work experience required with 2 years experience in Group Health Insurance and Self-Funded Health Plans.

Experience & Skills

• Strong verbal and written communication skills.
• Excellent interpersonal, customer service, organizational, and time management skills.
• Analytical and problem-solving ability in complex scenarios.
• Preferred experience in Medicare, Medicaid, Case Management and prescription drug benefits.
• Proficiency with Microsoft Office Suite.

Competencies

Job Knowledge, Time Management, Accountability, Communication, Initiative, Customer Focus.

Physical Demands & Work Environment

Ability to sit for long periods, communicate via telephone. This is a remote position requiring reliable cable broadband or fiber optic internet with minimum speeds of 100Mbps download/25Mbps upload.

Compensation & Additional Details

Compensation includes competitive base salary and total rewards such as Medical, Dental, Vision, Life & Disability Insurance, Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Duties may be amended as needed.

Key skills/competency

• Case Management
• Clinical Evaluation
• CMS Communication
• Care Coordination
• Vendor Management
• Health Insurance
• Problem-solving
• Administrative Tasks
• Time Management
• Customer Service