Manager

• Exercise independent clinical judgment and strategic planning in managing a caseload of members with complex medical and behavioral health needs according to department processes and duties.
• Recommend care coordination strategies for members, including but not limited to, the following:
• Apply brief medical/behavioral interventions and evidence-based methodologies as necessary to enhance the member’s ability to manage their own health.
• Lead the development of individualized care plans (ICPs) or discharge plans through comprehensive biopsychosocial assessments and interdisciplinary collaboration.
• Develop and communicate ICP with the member, approved family or caregiver and other members of the care team.
• Facilitate and guide interdisciplinary care team meetings, influencing care plan modifications and alignment with member goals.
• Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate.
• Initiate and oversee quality improvement initiatives and projects that address clinical gaps (e.g., HEDIS measures), improve health outcomes, and support innovation.
• Identify, develop, and test new practices for improving member health outcomes.
• Advocate for timely, high-quality care for members by coordinating with internal partners and external providers across the continuum of services.
• Utilize clinical tools and metrics (e.g., PHQ scores, ER visit trends, hospitalization trends, substance use trends) to inform interventions, manage caseloads, and escalate high-risk cases appropriately.
• Design transitional care strategies for members shifting between care settings, ensuring coordination of services such as home health, DME, and primary care follow-up.
• Implement targeted outreach approaches to support care continuity, promote resource linkage, and empower member self-efficacy across care transitions.
• Cultivate and sustain productive partnerships with providers, team members, and community stakeholders.
• Employ advanced communication methods to strengthen collaboration across in-person, telephonic, and digital platforms.
• Ensure clinical documentation adheres to all applicable state, federal, and accreditation standards.
• Drive audit readiness and reporting integrity through proactive compliance oversight.
• Serve as a subject matter resource by providing formal and informal education to peers and cross-functional staff on medical conditions, treatment protocols, and emerging evidence in behavioral/medical health care.
• Participate in staff meetings, trainings, cross-functional committees, department planning initiatives, and professional conferences to represent Medical and Behavioral Health perspectives and contribute to strategic alignment with organizational goals.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Care Manager, RN

Safety Assurance and Certification Manager

Senior Business Intelligence Manager – Lead Member of Staff

Government/Customer Property Manager

Manager, Pharmacometrician