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Role Description

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.

Qualifications

• Minimum Bachelor of Science Degree
• BS in Social Work Preferred
• 3-5 years minimum in social services role.
• Intermediate level work experience with Microsoft Office, Word, Excel, Access, and PowerPoint software applications.
• Strong written and verbal skills.
• Preferred (LMSW, LCSW, CCM) but not required.

Requirements

• Job Knowledge
• Time Management
• Accountability
• Communication
• Initiative
• Customer Focus

Physical Demands

This is a standard desk role – long periods of sitting and working on a computer are required.

Work Environment

Remote

Benefits

• Medical, Dental, Vision, Life & Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend