Job Summary

Job Duties

• Completes structured clinical assessments for identified patients.
• This requires knowledge of medical terminology, diagnostic criteria, and chart review.
• Designs an individualized plan of care with the member and fosters a team approach by working collaboratively with the member, family, primary care provider, and other members of the health care team to ensure coordination of services.
• Works closely with assigned primary care provider site and functions as a case manager for patients with behavioral health co-morbidities across the care team to develop and maintain positive working relationships with patients, families and providers.
• Implements clinical interventions based on risk stratification and evidence-based clinical guidelines in conjunction with the primary care provider or specialist.
• Contacts patients through written correspondence and telephone calls, and conducts follow-up interviews.
• Provides clinical oversight and guidance to team members.
• Participates in data collection, health outcomes reporting, clinical audits and programmatic evaluation related to government initiatives.
• In partnership with the care team, identifies patients at risk for poor outcomes or experiencing poor coordination of services who would benefit from more intensive follow up.
• Provides chronic disease and self-management education and support.
• Conducts in-home member assessments for high risk and complex patient cases.
• Develops collaborative relationships with community based agencies to improve care, services and access for Health Plan membership.
• Evaluates practices of self and colleagues against standards of practice and relevant regulations and acts to improve compliance.
• Maintains required documentation for all case management activities.
• Collects required data and utilizes this data to adjust the treatment plan when indicated.

Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.

Position Details

Education

Experience

Certification(s) and License(s)