Care Management Specialist II
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Overview
Job Description
Position: Care Management Specialist Location: Downers Grove, IL (Remote, training is on-site and travel is required to homes/facilities)Employment Type: Full-Time ContractPay: $38 per hour Description: This position is responsible for discharge care coordination, episodic case management and pre-admission/post-discharge counseling for acute conditions. This position is responsible for handling duties in an independent manner and may assist other staff. Responsibilities:
- Coordinate discharge planning, transitions of care, and episodic case management, including pre- and post-discharge support
- Collaborate with physicians, providers, and care teams to assess needs, develop care plans, and ensure appropriate patient outcomes
- Educate members on treatment plans, medications, and post-operative care to reduce readmissions and ER utilization
- Conduct outreach and engagement based on risk assessments, addressing barriers to care and supporting follow-up compliance
- Coordinate services and referrals to community resources, transportation, home health, and specialty providers
- Reconcile medications and monitor adherence to ensure patient safety and regulatory compliance
- Assist members in navigating the healthcare system, including provider selection and appointment scheduling
- Monitor cases for quality issues and escalate to QA/QI as needed
- Support care coordination through documentation, communication, and participation in transition of care programs
- Ensure compliance with HIPAA, regulatory standards, and organizational policies while maintaining confidentiality
Requirements:
- Licensed Clinical Professional Counselor (LCPC) or Licensed Clinical Social Worker (LCSW) with current, active, unrestricted license in the state of Illinois
- 2 years of clinical experience and 1 year of health insurance/managed care experience
- Knowledge of medical management policies and procedures
- PC and database experience
- Verbal and written communication skills
- Customer service skills and interpersonal skills to discuss pre/post admission care with physicians, hospital staff and members
- Ability and willingness to occasionally travel within assigned location
- Possess transportation and current, valid driver's license for applicable state.
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