Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
· Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
· Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
· Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
· Provide patient and provider education
· Facilitate member access to community based services
· Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
· Actively participate in integrated team care management rounds
· Identify related risk management quality concerns and report these scenarios to the appropriate resources.
· Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
· Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
· Direct care to participating network providers
· Perform duties independently, demonstrating advanced understanding of complex care management principles.
· Participate in case management committees and work on special projects related to case management as needed