Case Manager

Job Title: Care Management / Care Coordination Specialist

Check all associated application documentation thoroughly before clicking on the apply button at the bottom of this description.

Job Location: IL (Remote+ Field visits in your local area).

Schedule: Monday–Friday, 8:00 AM–5:00 PM

Required Experience: 2+ years

Job Summary:

The Care Management/Care Coordination Specialist provides support for long-term services and supports (LTSS) and collaborates with multidisciplinary teams to coordinate integrated care for members with complex or high-need conditions. The role focuses on helping members achieve desired outcomes while supporting quality, cost-effective care across the continuum.

Key Responsibilities:

• Complete comprehensive member assessments within required regulatory timelines, including in-person home visits when required.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement individualized care plans and waiver service plans in collaboration with members, caregivers, physicians, healthcare professionals, and support networks.
• Monitor care plans, evaluate effectiveness, document interventions and progress, and recommend changes as needed.
• Coordinate behavioral health, LTSS, home, and community-based services to promote continuity of care.
• Assess medical necessity and authorize appropriate waiver services.
• Evaluate covered benefits and provide guidance regarding available funding sources.
• Facilitate interdisciplinary care team (ICT) meetings for service approvals or denials and support informal ICT collaboration.
• Use motivational interviewing and clinical guideposts to educate, support, and motivate members.
• Identify barriers to care and coordinate resources to address psychosocial, financial, and medical needs.
• Identify critical incidents and develop prevention plans to support member health and safety.
• Collaborate with licensed care managers and leadership as needed.
• Travel locally approximately 25–40% of the time, based on state and contractual requirements.

Required Qualifications:

• Minimum of 2 years of healthcare experience , including:
• At least 1 year of experience working with individuals with disabilities, chronic conditions, or long-term services and supports (LTSS), and
• At least 1 year of experience in care management; or experience in a medical and/or behavioral health setting; or an equivalent combination of education and experience.
• Valid and unrestricted driver's license.
• Reliable transportation and adequate auto insurance for work-related travel, unless otherwise required by law.
• Knowledge of community resources and support services.
• Ability to work effectively with diverse populations and adapt to different settings and situations.
• Strong attention to detail, initiative, and ability to work independently with minimal supervision.
• Ability to remain calm and responsive in high-pressure situations.
• Strong relationship-building and communication skills.
• Excellent time-management, prioritization, problem-solving, and critical-thinking skills.
• Ability to manage multiple priorities and adapt to changing needs. xxzpjkt
• Proficiency with Microsoft Office and the ability to navigate online portals and databases.