Nashville, United States
over 1 year ago
The Disease Management Case Manager is responsible for monitoring the progress and quality outcomes of the Disease Management Associates and provides clinical oversight to the team. Responsible for identifying high risk patients for disease management intervention and coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of alternative treatment plans that address individual needs of the member, their benefit plan, and community resources. Directs intervention with moderate to high risk members, and provides support and oversight to other team members managing low risk members. Interfaces with providers of behavioral health services, medical services and equipment to facilitate effective communication, referrals, development of discharge planning and alternative treatment plan development. Evaluates cases for quality of care. Understands and follows policies and procedures and produces and submits reports in a timely manner. Serves as a behavioral health professional resource to Disease Management Associates. Initiates and leads Disease Management case staffing meetings.