POSITION SUMMARY

The Enhanced Case Management Specialist position will have a full understanding of the Enhanced Case Management (ECM) suite of strategies and supports the Enhanced Care Advocate and ECM team. The Specialist will primarily focus on vendor, carrier, and Center for Medicare and Medicaid Services (CMS), and member communication.

ESSENTIAL FUNCTIONS

• Identifying and communicating coverage options available to a member under various

scenarios (i.e. member qualifying event, obtaining age 65, etc.).

• Implement and coordinate with the member, client, Allied, and various vendor

partners.

• Communicate with (CMS) to obtain essential member information.

• Facilitate and maintain prescription drug vendor relationships, negotiate pricing as

needed, manage member set-up and provide on-going support.

• Review clinicals, claims and baseline case information for Behavioral, Wellness, and

Specialty Prescription support needs and map a plan with the resources available.

• Work closely with the Case Management team and Case Managers to obtain clinical

information.

• Assist in troubleshooting and resolving escalated issues.

• Execute assorted weekly and monthly administrative tasks

• Act as the liaison between the client/broker/member and Allied Executives and Various

Departments.

• Troubleshoot, identify and collaborate to improve internal processes within Enhanced

Case Management and the various Allied departments.

• Produce and analyze Ad Hoc reporting when requested.

• Provide training to clients and brokers as needed.

EDUCATION

• Bachelor’s degree or equivalent work experience required.

EXPERIENCE & SKILLS

• 2 years of experience with Group Health Insurance and Self-Funded Health Plans required.

• Excellent verbal and written communication skills.

• Excellent interpersonal and customer service skills.

• Excellent organizational skills and attention to detail.

• Excellent time management skills with a proven ability to meet deadlines.

• Ability to review information, assess the problem, and propose viable solutions.

• Strong analytical and problem-solving skills.

• Medicare, Medicaid, Case Management and prescription drug benefit experience preferred.

• Experience in a clinical or social work position a plus.

• Experience working in a hospital system a plus.

• Life and Health Insurance Producers License is preferred, but not required.

• Proficient with Microsoft Office Suite or related software.

COMPETENCIES

• Job Knowledge

• Time Management

• Accountability

• Communication

• Initiative

• Customer Focus

PHYSICAL DEMANDS

• Ability to sit for long periods of time. Ability to communicate via telephone.

WORK ENVIRONMENT

• Remote

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.