Professional Management Enterprises, Inc.

Case Manager I (BEP Illinois)
Other Area(s)
Illinois Contract Apr 10, 2023
Must live in South-East Lake County and North-East Cook County. Skokie/Evanston area.
  • Responsible for health care management and coordination of  Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and Healthcare ?s progress and services to ensure consistent cost-effective care that complies with Healthcare policy and all state and federal regulations and guidelines. Provides case management services to members with chronic or complex conditions including Proactively identifies members that may qualify for potential case management services.
  •  Conducts assessment of member needs by collecting in-depth information from information system, Healthcare member, members family/caregiver, hospital staff, physicians, and other providers.  Identifies, assesses manages members per established criteria. Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Documents care plan progress in Healthcare information system.  Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
  • Measures the effectiveness of interventions to determine case management outcomes.  Promotes integration of services for members including behavioral health and long-term care to enhance the continuity of care for Healthcare members.  Conducts face to face or home visits as required.  Maintains department productivity and quality measures.  Manages and completes assigned work plan objectives and projects in a timely manner.  Demonstrates dependability and reliability.  Maintains effective team member relations. Adheres to all documentation guidelines.  Attends regular staff meetings. Participates in Interdisciplinary Care Team (ICT) meetings.  Assists orientation and mentoring of new team members as appropriate.  Maintains professional relationships with provider community and internal and external customers.  Conducts self in a professional manner at all times. 
  •  Maintains cooperative and effective workplace relationships and adheres to the company Code of Conduct. ? Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.  Complies with required workplace safety standards.
  •  Bachelor?s degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree)
  • 0-2 years of clinical experience with case management
  • Required Licensure/Certification: Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW
  • Must have valid drivers license with good driving record and be able to drive locally
  • Demonstrated ability to communicate, problem solve, and work effectively with people. ? Excellent organizational skill with the ability to manage multiple priorities
  • Work independently and handle multiple projects simultaneously. 
  • Knowledge of applicable state, and federal regulations
  • Knowledge of ICD-9, CPT coding and HCPC. ? SSI, Coordination of benefits, and Third-Party Liability programs and integration