Job Description
Market leading healthcare organization is hiring for a Licensed Social Worker Case Manager in IL. This is a hybrid role working from home and traveling in the field in the St Clair County, IL area (mileage is reimbused)!
Duties:
Evaluation of Members:
- Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.
o Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
o Coordinates and implements assigned care plan activities and monitors care plan progress.
- Enhancement of Medical Appropriateness and Quality of Care:
o Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
o Identifies and escalates quality of care issues through established channels.
o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
o Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
o Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
- Monitoring, Evaluation and Documentation of Care:
o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Requirements:
-Must have an active IL license or certification in a healthcare related field
Must reside in the state of Illinois in the St Clair County Illinois area
- Valid Illinois Driver's license
- Willing and able to travel up to 75% of their time to meet with members face to face
- Reliable Transportation required, eligible for mileage reimbursement as per company policy.
- Minimum of two (2) years of case management experience
- Microsoft Office and electronic health record experience
Schedule: Monday-Friday 8am-5pm CST
Potential for long term based on performance!
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Temporary work, Work experience placement, Work at office, Monday to Friday