Care Management Specialist II

Job Title: Care Management Specialist IILocation: Remote in ILJob Type: W2 ContractExpected hours per week: 40 hours per weekSchedule: 8am-5pm CSTPay: $40 per hourNote: Candidates should be located in the Greater Chicago or Springfield/Southern IL area in the event that training may be on-site.

Position Summary (Please read the job description thoroughly)

This position is responsible for discharge care coordination, episodic case management, and pre-admission/post-discharge counseling for members experiencing acute conditions. The role focuses on supporting members through the transition of care process to ensure continuity, reduce readmissions, and promote positive health outcomes.

The clinician works independently, establishes short-term relationships with members during the immediate post-discharge period, provides education and resource coordination, and determines case complexity for appropriate referrals to internal or external programs.

Essential Functions

• Coordinate discharge planning, episodic case management, and pre-admission/post-discharge counseling.
• Consult with physicians, care coordinators, hospital staff, and facility discharge planners to identify appropriate resources and alternate treatment options.
• Provide education, counseling, and referrals to reduce hospital readmissions and emergency room utilization.
• Perform Transition of Care services for all assigned lines of business.

• Assess, plan, coordinate, monitor, and evaluate services to meet acute health needs.

• Personalize outreach and engagement based on member attitudes, behaviors, and risk assessments.

• Communicate with providers to coordinate care and notify them of risks or new conditions.
• Reconcile medications, educate members, and monitor medication adherence and safety.
• Reinforce provider instructions related to post-operative care, diet, activity, and follow-up care.
• Identify and address barriers to follow-up appointments; assist with scheduling when needed.
• Assist members in locating primary care providers, specialists, Blue Distinction Centers, or Customer Service support.
• Arrange transportation to provider appointments when all other options have been exhausted.
• Refer members to internal programs or external/community-based resources (e.g., transportation, home health, social services).
• Provide on-site, face-to-face interventions in select cases.
• Educate members on condition management, risk reduction, behavior change, and self-management.
• Collaborate with providers and members to develop alternate care plans when appropriate.
• Assist members and providers with navigating the healthcare system.
• Identify potential quality-of-care issues and refer cases to Quality Assurance/Quality Improvement (QA/QI) for review.
• Assess case complexity and refer to Case Management, Disease Management, or Enterprise Lifestyle Management programs as appropriate.

Job Requirements

• Registered Nurse (RN) OR

• Licensed Master Social Worker (LMSW) OR

• Licensed Clinical Professional Counselor (LCPC)
• Must hold a current, active, unrestricted license in the state of operations (or reciprocity if applicable).

Experience

• Minimum 2 years of clinical experience

• Minimum 1 year of health insurance or managed care experience
• Experience working with youth populations preferred (e.g., Mobile Crisis Response, DCFS, Pathways, special needs children)

Skills & Competencies

• Knowledge of medical management policies and procedures
• Strong verbal and written communication skills
• Excellent customer service and interpersonal skills
• Ability to collaborate with physicians, hospital staff, and members
• Proficiency with PCs and database systems
• Ability to work independently and manage multiple priorities

Travel Requirements

• Willingness to occasionally travel within the assigned area

• Must have reliable transportation and a valid driver’s license for the applicable state

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