Manager

• Responsible for care management within the scope of licensure for members with complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum
• Conduct assessments to identify individual needs and a specific care management plan
• Implement care plan by facilitating authorizations/referrals as appropriate
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate effectiveness of the care management plan
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans
• Negotiate rates of reimbursement, as applicable
• Assist in problem solving with providers, claims or service issues
• Participate in department audit activities

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