Case Manager RN- Field (Central/Eastern Illinois)

• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care
• Interacts with members/clients telephonically or in person
• May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status
• develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate
• Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person
• Prepares all required documentation of case work activities as appropriate
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes
• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate
• Provides educational and prevention information for best medical outcomes
• Applies all laws and regulations that apply to the provision of rehabilitation services
• applies all special instructions required by individual insurance carriers and referral sources
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data
• Utilizes case management processes in compliance with regulatory and company policies and procedures
• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration
• Monitors member/client progress toward desired outcomes through assessment and evaluation

• Minimum 3-5 years clinical practical experience preference required
• Minimum 2-3 years CM, discharge planning and/or home health care coordination experience
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
• Efficient and Effective computer skills including navigating multiple systems and keyboarding
• Registered Nurse with active state license in good standing within the region where job duties are performed is required

Certified Case Manager is preferred

• Medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• bonus, commission or short-term incentive program