Manager

• Ensures member access to services appropriate to their health needs
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
• Coordinates internal and external resources to meet identified needs
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary
• Assists in problem solving with providers, claims or service issues
• Coordinate referrals to local and statewide resources including behavioral health, housing, transportation, and food assistance
• Partner with community health organizations, advocacy groups, and outreach teams to strengthen member connections
• Plan, coordinate, and deliver educational events in collaboration with community partners, employers, or local health organizations
• Provide group-based and one-on-one education on chronic conditions, medication adherence, preventive screenings, nutrition, and self-care
• Support initiatives that address health equity and promote culturally responsive care
• Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff
• Participates in department audit activities

Senior Nurse Case Manager – Field Nurse

Foster Care Case Manager

Academic Online Bookstore Manager