POSITION SUMMARY:

This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.

 

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures.


• Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes.


• Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges.


• Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention.


• Coordination of services for members, including community resources and collaboration with other members of the care team.


• Educate members and their caregivers on conditions and self-management techniques.


• Participate in elements of the SNP MOC, including completing HRA and working with the member to reach desired goals, under the direction of the assigned Case Manager


• Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care.