About the job
Daily Responsibilities:
- Role Overview: Engage in the daily operations of the Integrated Case Management functions, focusing on high-risk members to identify their needs and aspirations, fostering empowerment and enhanced quality of life across both behavioral and physical health domains.
- Conduct assessments of the members' current functional status, and collaboratively develop and oversee the Case Management Care Plan, ensuring quality of care, assisting in discharge planning, and participating in specialized clinical projects while liaising with departmental and administrative staff to streamline operations.
- Work closely with both medical and behavioral health providers to guarantee the best outcomes for members.
- Utilize telephonic communication to connect with high-risk patients and their healthcare providers, identifying needs, setting objectives, and implementing actionable steps to achieve those objectives.
- Empower patients to enhance their quality of life by adopting a holistic approach to address complex health challenges.
- Adhere to NCQA guidelines and HEDIS measures to maintain compliance.
- Follow established referral, pre-certification, and authorization protocols as directed by Medical Management personnel.

