Nashville, United States
6 months ago
Under general supervision, responsible for identifying high risk patients for behavfioral health case 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. 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.
Initiate contact with patient/family, physician, and health care providers/suppliers to discuss the alternative treatment plan and conduct on-site or in-home evaluations as necessary.
Monitors, evaluates, extends, revises or closes treatment plans as appropriate.
Evaluates cases for quality of care.
Communicates case management decisions.
Understands and follow policies and procedures and produces and submits reports in a timely manner.