In this role, the selected candidate will assist members in identifying modifiable risk factors and referring and leveraging the coaching resources provided by employer to coach on lifestyle change, including weight management, quitting tobacco, stress reduction, nutrition and increasing physical activity.
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit design and/or acute health needs through communication and available resources to promote optimal, cost-effective outcomes.
In this role, you will provide case management to members who are identified (specifically members being discharged from hospital admissions) in accordance with companies Medical Management policies and procedures.
In this position, you will manages the activities of supervisory associates and their subordinate work group(s) and/or exempt individual contributors for assigned area of responsibility. Works with the Supervisor(s) and Case Managers to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member.
In this role, the Transition Case Manager will be responsible for managing the care of high risk patients, community clients or populations that are at risk for poor health outcomes and frequent hospital re-admissions.
In this role, you will plan, implements, manages and evaluates the provision of services to ensure that all members needs to met and quality care is provided in accordance with Federal, State and Agency guidelines.
This position is responsible for having a thorough understanding of patient treatment plans through participative discussions with the care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing inpatient and outpatient services requiring MCO approval.
In this role, you will be assisting in developing strategic plan by partnering with Assistant Director and Fund management to identify opportunities that have direct impact on clinical and financial outcomes.