Manager

• Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes
• Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care
• Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care of services
• Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
• May identify problems/barriers for care management and appropriate care management interventions for escalated cases
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Performs telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits

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