Manager

• responsible for care management within the scope of licensure for members with complex and chronic care needs
• assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
• Ensures member access to services appropriate to their health needs
• Conducts assessments to identify individual needs
• Implements care plan by facilitating authorizations/referrals as appropriate
• Coordinates internal and external resources to meet identified needs
• Monitors and evaluates effectiveness of the care management plan
• Interfaces with Medical Directors and Physician Advisors
• Assists in problem solving with providers, claims or service issues
• Assists with development of utilization/care management policies and procedures

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