Quality Manager leading the PRI Quality Management System while embedding quality principles across the organization. Collaborating with senior leaders for operational excellence and compliance.
About the role
- Case Manager RN coordinating health services for Medicare and Medicaid populations. Collaborating with members and providers to meet health and social needs in Illinois.
Responsibilities
- Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities
- Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work
- 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
- 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
- Provides educational and prevention information for best medical outcomes
- Utilizes case management processes in compliance with regulatory and company policies and procedures
- Monitors member/client progress toward desired outcomes through assessment and evaluation.
Requirements
- 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
- Candidates must live in or near Arlington Heights, Rolling Meadows, Glenview, Palatine, Mount Prospect, Northbrook, Wooddale, Prospect Heights
- Must possess reliable transportation and be willing and able to travel up to 75% of the time.
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
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