Enhanced Case Management Advocate
POSITION SUMMARY Support Allied’s Enhanced Case Management Services by communicating directly with identified plan members to assist them in understanding all benefit options available to them and/or their family. This may include options through the employer, alternative coverages (i.e., spouse’s coverage, government programs, etc.), and other means. Strong verbal and written communications skills are essential in addition to decision making skills. ESSENTIAL FUNCTIONS
- Identify individuals from our ASO Self-Funded and Co-Sourcing Partially Self-Funded Clients based on current medical condition(s), future claim costs, and current financial assessment for Enhanced Case Management evaluation and identify strategic options.
- Facilitate ongoing member and/or family engagement under Enhanced Case Management to determine prospects of the member participating in ECM.
- Produce and Review Financial Analysis/Assessments (Contributions and OOP Expenses under the Group Health Plan versus Alternative Option) with Member and/or Family to determine the best options for the member.
- Assist members and/or families in enrolling in CMS programs – Medicaid and/or Medicare – along with other assistance programs (i.e., American Kidney Fund Grant) and/or any other coverage that the member may be eligible (i.e., Exchange-Based Coverage).
- Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member set-up and provide on-going support.
- Work with Account Executive/Account Manager to discuss the case with Designated Member Employer Group.
- Strategize on a regular basis with VP, Risk and the ECM Team to discuss progress of current caseload.
- Document and track time spent on each Enhanced Case Management Member.
- Assist the Director, Account Services in identifying ways to streamline and improve efficiencies, define processes, workflows, and ensures that quality assurance standards are followed.
- Performs other related duties as assigned
EDUCATION
- Minimum Bachelor of Science Degree
- BS in Social Work Preferred
EXPERIENCE AND SKILLS
- 3-5 years minimum in social services role.
- Intermediate level work experience with Microsoft Office, Word, and Excel Access and Power Point software applications.
- Strong written and verbal skills
- Preferred (LMSW, LCSW, CCM) but not required
POSITION COMPETENCIES
- Accountability
- Analytical Thinking
- Collaboration
- Communication
- Customer Focus
- Functional Expertise
- Initiative
PHYSICAL DEMANDS
- This is a standard desk role – long periods of sitting and working on a computer are required.
WORK ENVIRONMENT
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Apply tot his job Apply To this Job