Manager

• Responsible for primarily working with a caseload of Members with medical needs.
• Responsible for utilizing brief medical interventions as necessary to improve the Member’s ability to manage their own health.
• Provide formal and informal training and support for Enhanced Care Management team Members on medical conditions, including treatments and evidence-base for treatment.
• Represents the Enhanced Care Management team as the lead member when necessary.
• Responsible for assisting Members with care coordination needs.
• Conduct comprehensive, holistic assessment according to the scope of the RN license.
• Assimilate assessment information into an individualized care plan (ICP).
• Communicate ICP with Member, approved family or caregiver and other Members of the care team.
• Lead inter/transdisciplinary care team meetings to share information, update and inform care plan.
• Coordinate with internal and external health partners to support Members comprehensive care needs.
• Participate and lead care transition plan responsibilities.
• Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.
• Responsible for promoting a collaborative and effective working environment within the Enhanced Care Management team by engaging in evidenced-based communication strategies (such as Motivational Interviewing).
• Responsible for building and maintaining a positive working relationship with Providers.
• Responsible for engaging with Members, both in-person and on the phone.
• Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects.
• Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
• Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
• Participates in Health Plan staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Team Members.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

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