Remote Utilization Management Nurse Jobs in Springfield, IL

Project work; could extend past 90 days at this time based on need and interest.
Clinical Role LCPC, LCSW or RN with current unrestricted state licensure in IL.
Required Field Based Position Must Have: Target Counties: Cook, Lake, Will, Kane, Winnebago, Rock Island IL resident who lives in one of the counties listed below and is interested in doing field case management with the elderly and individuals with disabilities who are approved for in-home or nursing facility care.
On each resume, please clearly list which city state county and zip code the candidate is applying for.
Field Role Target Counties: Cook, Lake, Will, Kane, Winnebago, Rock Island Field Based Case Managers: Caseloads typically range from 30 to 100 members, depending on market needs and complexity of members needs. Mileage reimbursement The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Requires an LCSW or LCPC or RN with unrestricted IL active license. Experience with case management.
Position will require travel to members' homes up to 50-75% travel.
Must live near areas listed due to travel requirement and will work at home in between visits.
We want someone who is organized, efficient, and can work independently.
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Duties
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate
administration of benefits
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Experience
Minimum 3-5 years clinical practical experience preferred
Minimum 2-3 years Care Management, discharge planning and/or home health care coordination experience preferred
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills.
Ability to work independently
Effective computer skills including navigating multiple systems and keyboarding
Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications
Position Summary
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Requires unrestricted driver's license and car.
Requires RN with unrestricted active license.
Requires an RN with unrestricted active license
Education
Requires an LCSW or LCPC or RN with unrestricted IL active license.
Experience with case management.
Case Management Certification CCM preferred
What days & hours will the person work
in this position List training hours, if different.
8am to 5pm CST Mon-Fri