Case Management Analyst

• Facilitate appropriate healthcare outcomes for members through care coordination, support and education
• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review
• Evaluate benefit plans and available internal and external programs or services
• Identify high-risk factors and service needs and refer to clinical case management or crisis intervention as appropriate
• Coordinate and implement assigned care plan activities and monitor progress
• Consult with case managers, supervisors, Medical Directors and other health programs to overcome barriers
• Present cases at case conferences for multidisciplinary review
• Identify and elevate quality-of-care issues through established channels
• Negotiate appropriate options and services to meet members’ benefits and healthcare needs
• Use influencing and motivational interviewing skills to promote member engagement and healthy behavior changes
• Provide coaching, information and support for independent medical and healthy lifestyle choices
• Help members participate knowledgeably in healthcare decision-making with providers
• Use case management and quality management processes in compliance with regulatory, accreditation and company requirements

• Minimum 2 years of experience in behavioral health, social services or human services field
• Minimum 2 years of case Management experience
• Willing and able to travel up to 50-75% of the time to meet members face to face in Rockford, IL and surrounding areas
• Reliable transportation required
• Bachelor's degree or non-licensed master level clinician required
• Degree must be in behavioral health or human services, including psychology, social work, marriage and family therapy, or counseling
• Case management and discharge planning experience preferred
• Managed Care experience preferred
• Microsoft Office experience preferred

Demonstrates expertise in care coordination and case management, with a strong focus on behavioral health and social services. Proficient in evaluating member needs, implementing care plans, and ensuring compliance with regulatory standards.

• Case Management Experience
• Behavioral Health Expertise
• Motivational Interviewing Skills
• Care Coordination
• Regulatory Compliance

• Care Management Tools
• Data Review
• Benefit Plan Evaluation
• Discharge Planning
• Quality Management Processes

• Influencing Skills
• Coaching
• Member Engagement
• Communication

• Bachelor's Degree in Behavioral Health
• Master's Degree in Human Services

• Managed Care
• Crisis Intervention
• Healthcare Outcomes
• Multidisciplinary Review
• High-Risk Factors

• Microsoft Office