Analyst, Case Management- Field

Region 7: Caddo, Bossier, Webster, Claiborne, Bienville, Red River, DeSoto, Sabine, Natchitoches

Position Summary

Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.

A Brief Overview
Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.

What you will do

• Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach, to overcome barriers to meeting goals and objectives.

• Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.

• Identifies and escalates quality of care issues through established channels.

• Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

• Delivers influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

• Assists in encouraging members to actively participate with their provider in healthcare decision-making.

• Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.

For this role you will need Minimum Requirements

• Degree in Health Care/Human Services related field

• Case Management Experience

• Strong customer service orientation and problem solving skills

• Excellent communication/telephonic skills

• Excellent motivational interviewing skills/ability to build rapport and trust telephonically

• Excellence in documentation and respecting compliance/regulatory standards

• Highly organized, remain self-driven without direct supervision

• Manage time effectively

• Achieve performance metrics

• Technology proficiency

• Highly organized, remain self-drive without direct supervision

• Ability to travel within 125 miles round trip for 1 day in the field

• Variable work scheduled with ability to work 2 days weekly until 9pm local time

Preferred Qualifications

• Bachelors and/or Master's Degree

• CCM certification

• Previous experience in managed care organization

Education

Degree in Health Care/Human Services related field required