BCVS Group

Case Management Specialist II

Posted on

February 25, 2025

Job Type

Contract

Role Type

Case Management

License

RN

State License

Illinois

Apply to This Job

Help & Resources

Company Description

Job Description

Position:- Care Management Specialist II Rate:- $43/hr. Location :- Fully Remote in Illinois Job Description This position is responsible for discharge care coordination, episodic case management and pre-admission/post-discharge counseling for an acute condition. This position is responsible for handling duties in an independent manner and may assist other staff. Establish relationship with the member through the immediate post discharge follow-up period or until all short term care needs are met. Provide education/local resource information and encourage member (self) education. Determine case complexity and refer to other internal departments as needed.

Requirements

Licensed Clinical Professional Counselor (LCPC), Registered Nurse (RN) or Licensed Master Social Worker (LMSW) with current, active, unrestricted license in the state of operations (or reciprocity if applicable). 2 years clinical experience. 1 year 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. Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

Need help crafting an effective cover letter and resume for this role?

Get access to our expert resources: our proven framework offers successful strategies, helps you find the best-fit positions, craft standout cover letters, optimize your resume, and much more.

Get Started

Responsibilities

Discharge care coordination, episodic case management and pre-admission/post discharge counseling and identification of alternate treatment options. Consult with physicians, coordinators, and facility discharge planners to determine other resources and appropriate disposition of such cases. Provide education, counseling and referral to other resources to minimize re-admissions and emergency room episodes. Perform additional ongoing functions to support the member in the transition of care process including more than one of the following: Consult with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor and evaluate options and services required to meet an individual's acute health needs, using communication and available resources to promote quality health outcomes. Personalize outreach/engagement based upon attitudes/behaviors/risk assessment. Outreach to provider to coordinate the member's care or to notify of risks/new conditions. Reconcile, educate and monitor adherence to medication safety. Reinforce provider post-operative instructions for care, diet, activity level etc. Address barriers to keeping follow-up appointments with appropriate provider and assistance with appointment scheduling. Assistance finding a primary or specialist provider, a Blue Distinction Center or any needed coordination with Customer Service. Assist with getting to a provider if needed when all other options have been exhausted. Referral to other BCC programs, or external resources community based organizations, transportation, home health etc. Provide on site face to face intervention in select cases. Education and recommendations to resolve conditions and risks, and support for behavior change/ self-management. Collaborate with the provider and member when appropriate to develop alternate plans of care if needed. Assist members/providers to navigate the health care system. Assess cases for quality of care issues and refer cases to the QA/QI department for review and follow up. Perform Transition of Care services for all assigned lines of business. Determine case complexity and may refer to Case Management/Disease Management/Enterprise Life Style Management department personnel as necessary. Practice within the scope of licensure. Participate as preceptor for orientation of new employees. Maintain licensure and maintain and enhance knowledge for designated area of licensure and regulatory standards by attending seminars, training sessions, etc. Communicate and interact effectively and professionally with co-workers, management, customers, etc. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. Maintain complete confidentiality of company business.9. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Apply to This Job

Help & Resources

Our Resources Designed for Success

Nurses who follow our proven framework increase their chances of landing a remote telehealth role by 5x!

Telehealth

Starter Pack

Telehealth

Pro Toolkit

Telehealth

Mastery Suite

Price

$34 $79 $149

Resume Template Package

Checkmark Checkmark Checkmark
Matching Cover Letter Checkmark Checkmark Checkmark
Matching Reference Page Checkmark Checkmark Checkmark
Resume Tips and Tricks Checkmark Checkmark Checkmark
Resume Optimization Guide Checkmark Checkmark
7 Nurse Resume Examples Checkmark Checkmark
20+ Professional Summary Examples Checkmark Checkmark
How to Structure Unique Career Experiences Checkmark Checkmark

✅Career Accelerator Success Guide

Checkmark
🔓Lifetime Premium Job Board Access

Checkmark
📈Job Application Tracker

Checkmark
⭐1:1 Expert Support & Mentorship

Checkmark

Basic

Telehealth

Starter Pack

$34

  • Checkmark

    Resume Template Package

    ATS optimized design for nurses

  • Checkmark

    Matching Cover Letter

  • Checkmark

    Matching Reference Page

  • Checkmark

    Resume Tips and Tricks

ADVANCED

Telehealth

Pro Toolkit

$79

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Resume Optimization Guide

  • Checkmark

    7 Nurse Resume Examples

  • Checkmark

    20+ Professional Summary Examples

  • Checkmark

    How to Structure Unique Career Experiences

BEST VALUE

Telehealth

Mastery Suite

$149

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Everything from Pro Toolkit

  • Checkmark

    Career Accelerator Success Guide

    Proven method for landing your dream role

  • Checkmark

    Lifetime Premium Job Board Access

  • Checkmark

    Application Tracker

  • Checkmark

    1:1 Expert Support