Job Description
Job Overview:We are seeking a dedicated and compassionate Clinical Case Manager (LCSW, LCPC, or LPC) licensed in Illinois to join our Value-Based Care Services team. In this role, you will support members in navigating the healthcare system, enhancing their overall wellness, and achieving their personal healthcare goals. Through a collaborative, member-centered approach, you will play a key role in improving quality of care, optimizing cost-effectiveness, and ensuring member satisfaction. This fully remote position offers flexibility and the opportunity to make a meaningful impact in the lives of individuals.
Key Responsibilities:
Analyze data to determine member eligibility for the Population Health Management Program.
Provide timely, effective, and equitable care coordination aligned with HMO processes.
Manage case assignments, including outreach, documentation, monitoring progress, and case closure.
Maintain accurate and compliant reporting and documentation in accordance with Federal/State regulations and NCQA standards.
Conduct telephonic outreach to members and providers for engagement and care coordination.
Support members in overcoming healthcare barriers by addressing social determinants, psychosocial factors, and individual motivators.
Educate members on healthcare navigation, promoting informed decision-making and cost-effective interventions.
Uphold confidentiality and compliance with all healthcare regulations, policies, and procedures.
Participate in Quality Management and Utilization Management (QM/UM) Committee Meetings, including preparation, data collection, and follow-up tasks (may require occasional in-person attendance).
Be available for rotational off-hour/weekend calls, if applicable.
Continuously pursue professional development to stay informed on evolving case management standards.
Fulfill additional responsibilities as assigned and per evolving program requirements.
Qualifications:
Active Illinois licensure as an LCSW, LCPC, or LPC.
Minimum of five years of experience in healthcare settings, including managed care organizations.
Strong knowledge of case management principles, healthcare systems, and reimbursement structures.
Experience with motivational interviewing and evidence-based care coordination strategies.
Excellent clinical judgment, communication, and interpersonal skills.
Strong organizational and problem-solving abilities with the capacity to prioritize and manage tasks efficiently.
Ability to work independently in a remote environment while handling fast-paced workflows.
Proficiency in Microsoft Office Suite (Word, Excel, Access, Outlook, PDF) and experience navigating multiple EMRs.
Secure high-speed internet connection and a dedicated home office with a locking door for privacy. Backup internet access may be required.
Compensation & Schedule:
Annual salary: $70,000.
Flexible scheduling options, including four 10-hour shifts.
Work hours available Monday through Friday, 6 AM - 6 PM CT (flexibility available after successful orientation and supervisor evaluation).
Benefits & Perks:
Remote Work: Enjoy the convenience of working from home with a fully remote setup.
Comprehensive Health Coverage: Medical, dental, and vision insurance to support your well-being.
Retirement Planning: 401(k) plan with a 3% employer match to support your financial future.
Life & Disability Insurance: Coverage for peace of mind, including voluntary life insurance options.
Employee Assistance Program (EAP): Resources for personal and professional support.
Flexible Time Off: Take time as needed to maintain work-life balance.
Parental Leave: Paid leave to support growing families.
Professional Growth: Learning and development opportunities to advance your career.
Equal Opportunity Employment Commitment:We are committed to fostering an inclusive and diverse workplace. Employment decisions are made without regard to race, religion, color, age, sex, sexual orientation, gender identity, national origin, citizenship, disability, military or veteran status, or any other protected category under applicable laws. Our goal is to create a welcoming and equitable work environment for all employees.
Data Privacy & Security Commitment:This role requires strict adherence to security policies and procedures to protect patient health information (PHI), personally identifiable information (PII), and company intellectual property. All employees must comply with security-specific responsibilities as defined by their role.
Remote Work Technical Requirements:As a fully remote position, employees must provide their own internet connection capable of video calls and secure system access. A minimum internet speed of 50 Mbps download / 10 Mbps upload is recommended. Please verify your connection with your provider or run a speed test to ensure compliance. Necessary work equipment will be provided at no cost to employees.
If you are passionate about supporting individuals on their healthcare journey and thrive in a remote, collaborative environment, we encourage you to apply!
Employment Type: Full-Time
Salary: $ 82,389.00 Per Year
Job Tags
Full time, Remote job, Home office, Flexible hours, Shift work, Weekend work, Monday to Friday,