Job Summary:
Provide specialty service care coordination to members. Ensure appropriate services are delivered by specialty providers and ensure continuity of care across services. Responsible for the total care plan, encompassing all services and plans related to beneficiaries. Provide case management complying with Conflict Free Case Management rules.
Primary Duties/Responsibilities:
May include, but are not limited to:
- Assist members with healthcare needs by ensuring providers and services are working together so that the member’s health is improved.
- Provide health education and coaching to members tailored to issues identified within treatment and service plans.
- Develop the Person-Centered Support Plan (PCSP) and provide choices for members in this process.
- Ensure compliance with the PCSP and assist with any resources needed or barriers to accessing treatment.
- Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services.
- Assist members with social determinants of health including access to exercise and healthy food.
- Promote activities focused on the health of a patient and their community, including outreach, quality improvement, and patient panel management.
- Coordinate community-based management of medication therapy
- Participates in staff meetings and clinical conferences.
- Ensures that performance guarantees are met or exceeded.
- Interfaces with external and internal customers to ensure optimal efficiency of service.
- Other duties and responsibilities as assigned.
