Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members.
Helps implement projects, programs, and processes for Case Management.
Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.
Position Summary:
see description and duties
Duties:
Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members.
Helps implement projects, programs, and processes for Case Management.
Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.
Job Description
Brief Overview
Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members.
Helps implement projects, programs, and processes for Case Management.
Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.
What you will do
• Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach.
• Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Delivers influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Assists in encouraging members to actively participate with their provider in healthcare decision-making.
• Conducts comprehensive evaluations of referred members' needs/eligibility using care management tools and recommends an approach to case resolution.
Experience:
• Basic awareness of problem solving and decision making skills
• 0-2 years work experience
Education:
fill later