In this role, the selected candidate conducts reviews for medical necessity of psychiatric/substance abuse cases utilizing professional knowledge while applying Beacon Health Options criteria consistently and render certification decisions that are within the scope of practice that is relevant to the clinical areas under review.
Works in collaboration with the PI Coordinators and Director of Quality to collect data to reflect trends within the interprofessional care coordination meetings related to quality and outcomes of services.
This position is responsible for working with foster and biological families in their home communities by offering comprehensive case management services. The goal of the position is to implement services for the long-term, leading to positive outcomes for the youth and families served.
The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit design and/or acute and chronic health needs through communication and available resources to promote optimal, cost-effective outcomes.
Promote the overall success of Population Health by effectively facilitating care and improving outcomes across all points of the health care continuum - preventive health and wellness, through chronic care management to end of life care.
In this role, the selected candidate will strategically manage a sales pipeline to create sales growth and maximize revenue opportunities. Routinely analyze pipeline coverage percentage and target, hit rate, and pipeline deal profile to ensure that pipeline supports achievement of monthly, quarterly and annual goals.
Manages the transition of assigned Post Acute patients from acute care setting to the skilled nursing facility and/or home setting utilizing face to face and telephonic outreach to accomplish the goals of the Post Acute Program. Care coordination and facilitation with hospital discharge planners, case managers and hospitalist to obtain Post Acute orders for engagement.
Works to enhance the quality of patient management and satisfaction and promotes continuity of care and cost effectiveness through integration of the functions of case management, utilization review/management and discharge planning.