Maryland Primary Care Physicians

Manager

• Responsible for the planning, development, implementation, and oversight of care plans for members with identified Care Management (CM) needs
• Manage the care management process by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources
• Conduct telephone or face-to-face interviews to assess risk factors and care management needs
• Initiate, develop, plan, and implement care plans designed to promote quality care and service for members

OB Care Manager

Pharmacist

• Work collaboratively with quality management to support HEDIS adherence projects
• Support the accurate implementation and coding of pharmacy benefits, formulary, and program changes
• Review pharmacy services recommended for denial and investigate data from plan providers
• Assist in the management of members by collecting pertinent information from plan providers and pharmacy data systems
• Assist in various pharmacy, utilization review/management, quality improvement, provider relations, and population health initiatives
• Serve as a pharmacy liaison and resource person to plan pharmacies and members
• Assist the Pharmacist with monitoring and evaluation of pharmacy utilization

Pharmacy Benefit Coordinator

• This role serves as the co-manager of SDoH programs, focusing on complex cases aligning with department SDoH operations.
• Responsible for co-managing the Social Determinants of Health (SDoH) strategy and vision for Maryland Physicians Care (MPC).
• Lead regional multidisciplinary teams of social workers and community health workers addressing the complex social needs of members that impact health outcomes.
• Ensure coordinated, high-quality, and cost-effective interventions.
• Responsible for advancing scalable workflows, collecting and analyzing performance metrics.
• Use data-driven insights to target services to members with the greatest need and opportunity for impact.
• Drive the advancement of integrated social care models by partnering across various departments and organizations.
• Manage social work ethics and mandated reporting.
• Implement and scale the overall strategy to address SDoH for members and communities.

Manager, SDoH

Community Health Worker

• Conduct intake interviews with members and complete the Social Determinants of Health (SDOH) assessment
• Communicate the purpose of the program to the members and the impact it may have on their well-being
• Help patients identify socio-economic issues that affect their overall health and develop health/social management plans and goals
• Partner with community organizations, governmental agencies, and local resources to develop productive relationships and programs
• Assist patients in understanding care plans and instructions
• Assist members in accessing health-related services, and overcoming barriers to obtaining needed medical care/social services
• Provide support and advocacy during medical visits or when necessary to ensure members' medical needs and referrals required are being conveyed
• Follow up with both members and providers regarding health/social services
• Maintains positive working relationships with members, providers, nurse case managers, agency representatives, and office staff, from diverse cultural and socio-economic backgrounds
• Works to reduce cultural and socio-economic barriers between members and institutions

Community Health Worker – SDoH

• Conduct intake interviews with members and complete the Social Determinants of Health (SDOH) assessment
• Communicate the purpose of the program to the members and the impact it may have on their well-being
• Help patients identify socio-economic issues that affect their overall health and develop health/social management plans and goals
• Partner with community organizations, governmental agencies, and local resources to develop productive relationships and programs
• Assist patients in understanding care plans and instructions
• Assist members in accessing health-related services and overcoming barriers to obtaining needed medical care/social services
• Provide support and advocacy during medical visits or when necessary to ensure members' medical needs and referrals required are being conveyed
• Follow up with both members and providers regarding health/social services
• Maintains positive working relationships with members, providers, nurse case managers, agency representatives, and office staff, from diverse cultural and socio-economic backgrounds

• Responsible for planning, development, implementation, and oversight of care plans for members
• Managing the care management process for high risk and special needs members
• Conducting clinical/social assessments in collaboration with physicians
• Fostering professional relationships with service providers
• Initiating and implementing care plans to promote quality care
• Maintaining care management records and data integrity

OB Care Manager

Pharmacy Benefit Coordinator

Manager, SDoH

Community Health Worker – SDoH

Community Health Worker – SDoH

Care Manager – RN