In this role, you will coordinate clinically complex patients care across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes, negotiating, procuring and coordinating appropriate services.
In this role, you will utilize regional population stratification information and processes to identify appropriate members for enrollment into case management in collaboration with clinicians and health care team.
In this role, you will communication with claimants, medical professionals, claims staff and others to obtain information necessary to make sound medical decisions. In addition, responds to various written, telephone in-person inquiries regarding status of case.
In this role, you will provide care coordination and management services for members with identified needs: Creatively using available and appropriate resources, including KP staff and providers, to support the unique needs of each member.