Utilization/Case Manager - NearTerm : Job Details

Job DescriptionOverviewPatient Care Management - Social Worker/ RNFull-Time + BenefitsM-F 8:00 AM - 5:00 PMProvide triage and care management for enrollees, responsible for utilization management relationships and provider relations.Help coordinate, plan and evaluate procedures in the delivery of care management, while meeting accreditations standards, under the direction of the Director of Managed Care.COVID-19 and Flu Vaccination Requirement: It is required to be vaccinated for COVID-19 and Influenza. Exemption requests based on medical or religious reasons may be submitted, but must be approved for active employment.Benefits - Our competitive Total Rewards program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you're in.Diversity, Equity and Inclusion Commitment - We're committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.Development - We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.Community Involvement - Be an essential part of our core purpose â to improve the health of the people and communities we serve.ResponsibilitiesCare ManagementProvides care management to designated enrollees.Assuring that all enrollees receive clinically sound triage/referral and ongoing care management services for behavioral health needsConsulting with the medical director on all high-risk cases, re-admissions and stays over six (6) daysProvides documentation of enrollee contacts and clinical care as it occursCoordination and participation in weekly calls with Medical DirectorsUtilization Management ResourceActs as a liaison to utilization staffs/providers and program directors.This includes annual face to face visits.Responds to all calls within one (1) business day.QualificationsEducation:Registered Nurse, master level social worker.Experience:5 years experience in the behavioral health field.License(s)/Certification(s):Unrestricted Registered Nurse licensed / licensed behavioral health clinician - Illinois/Iowa license is required.Knowledge/Skills/Abilities:Basic computer knowledge using word, spreadsheet, email.#QC123Area of Interest:Nursing;FTE/Hours per pay period:1.0;Department:Prec Carve Out;Shift:8:00 am to 5:00 pm Monday through Friday.#J-18808-Ljbffr