Manager

• Conduct meaningful outreach, provide education, and drive member enrollment
• In partnership with the member, create a Service Plan to guide engagement based on member diagnoses, results of screenings, as well as care gaps
• Build measurable goals for members to develop skills and/or strategies for managing challenges and triggers to reduce hospital admissions/readmissions and use of the ER, and record outcomes
• Coordinate community resources for each member to support them in achieving their goals as outlined in their Service Plans, created with an emphasis on meeting behavioral health and medical needs, and closing gaps identified in the social determinants of health
• Act as an advocate and liaison between the care team (family, physician, facilities, and/or agencies) and member
• Schedule appointments, build accountability, and follow-up services for members
• Elevate critical incidents and information regarding any quality-of-care concerns
• Report hospital diversions, productivity, and other outcomes weekly
• Prepare and maintain all required records, reports, consents, and members’ diagnostic records

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