Maryland Primary Care Physicians

Manager

• Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members.
• Serves as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs.
• Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management.
• Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members.
• Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs.
• Utilizes clinical judgment to discharge members from care management according to plan policies and procedures.
• Maintains care management records according to plan policies and procedures and ensures data integrity in health plan information systems.
• Collects, evaluates, and reports clinical, functional and program activity as applicable.
• Educates members' medical providers regarding the members' special needs to ensure consideration to the unique needs of the patients in treatment planning.
• Coordinates and communicates with community support and social service systems for members.
• Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
• Assists with special projects to meet plan and departmental goals.

Care Manager, RN