McAllen, United States
10 months ago
Responsible for collaborating with healthcare providers and members to optimize the members benefits to promote effective use of resources. Required to provide guidance to members regarding barriers to managing their health conditions. Assists members to change behaviors and to locate and access interpersonal, family, and community resources that will make it easier to manage their health.
Essential Duties and Responsibilities:
Conducts face-to-face and telephonic member assessments (health risk assessments and other assessments).
Works with member, members family, and providers to facilitate a comprehensive individualized service plan.
Uses clinical judgment to identify physical and behavioral health needs, works with the member and caregiver, and making appropriate referrals.
Works with member to close clinical and pharmacy gaps and to mitigate non-clinical barriers to care.
Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions.
Completes and files all assessments and implements the plan of care within the timelines outlined by the state.
Actively participates in all Health Services staff meetings. Other duties as requested;
Delivers professional activities in the Case Management job family. Coordinates enrollee care needs across the continuum for assigned members who are medically stable, but require primary psychosocial support and acute intermittent medical support. Interviews members and relatives to obtain social history relevant to medical problems and care planning. Assists members with environmental difficulties that interfere with obtaining maximum benefits from medical care. Serves as a liaison between primary care team, members, relatives and appropriate outside agencies. Applies standard techniques and procedures to routine instructions that require professional knowledge in specialist areas. Provides standard professional advice and creates initial reports/analyses for review. May provide guidance, coaching, and direction to more junior members of the team in Case Management. May require a LPN.