Manager

• Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.
• Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures.
• Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care.
• Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits.
• Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc.
• Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care.
• Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care.
• Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member.
• Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.

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