Manager

• Perform 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
• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and a specific care management plan
• Implement care plan by facilitating authorizations/referrals
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate effectiveness of the care management plan and modify as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Negotiate rates of reimbursement, as applicable
• Assist in problem solving with providers, claims or service issues

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