* Improve Health Outcomes
* Activities to Prevent Hospital Readmission
* Improve Patient Safety and Reduce Medical Errors
* Wellness & Health Promotion Activities
* Assesses referred cases or other available data to identify clients who would benefit from care management services. Assess participant needs and theory of change utilizing a holistic point of view.
* Provides utilization review, preauthorization, case management, disease management and medical claims review as indicated.
* Preauthorizes services according to established criteria.
* Assesses the needs of the client and family and identifies treatment alternatives that promote quality, cost-effective outcomes.
* Reviews pertinent medical history, current diagnosis, and pharmaceutical data via information database system.
* Communicates with practitioners, providers, clients, family members, Medical Directors, and appropriate QualChoice personnel regarding client needs and treatment alternatives.
* Coordinates development, approval, and implementation of care plans.
* Utilizes readiness for change, locus of control assessments and productivity measures to guide care.
* Assists clients in forming solutions for presenting problem and co-defines and determines realistic goals with participant.
* Determines and provides relevant community and/or healthcare resources that help support participant’s theory of change and effective and efficient medical utilization.
* Educates members and coaches to a healthy lifestyle according to established criteria.
* POSITION DESCRIPTION POSITION: Care Manager
* Establishes and maintains good working relationships with physicians, hospital staff, allied provider contacts, clients and families.
* Directs member to network providers, community resources, online resources and employer sponsored services according to the needs of the client.
* Coaches the client utilizing motivational interviewing techniques.
* Monitors the effectiveness of care management plans in achieving quality, cost-effective outcomes, through ongoing communication with clients, families, physicians, and other providers, as well as medical record review and/or onsite client evaluation. Facilitates changes in care plans as indicated.
* Assures that Medical Director and departmental management are informed of care status according to established procedures. Seeks direction on medical or administrative issues as needed. Documents according to accepted medical record standards consistently and thoroughly.
* Provides documentation as needed to ensure proper claims payment.
* Effectively assesses, coaches and graduates clients from care, resulting in appropriately managed caseloads.
* Maintains open lines of communication within the organization.
* Is familiar with and functions within national Health coaching and Care Management standards.
* Manages care in a compassionate, quality, cost effective manner.
* Fosters a team relationship with other department staff.
* Other duties as assigned.
* Assesses referred cases or other available data to identify clients who would benefit from care management services. Assess participant needs and theory of change utilizing a holistic point of view.
* Utilize readiness for change, locus of control assessments and productivity measures to guide care.
* Assesses the needs of the client and family and identifies treatment alternatives that promote quality, cost-effective outcomes.
* Review pertinent medical history, current diagnosis, and pharmaceutical data via information database system.
* Communicates with practitioners, providers, clients, family members, Medical Directors, and appropriate QualChoice personnel regarding client needs and treatment alternatives.
* Coordinates development, approval, and implementation of care plans.
* Assists clients in forming solutions for presenting problem and co define and determine realistic goals with participant.
* Determine and provide relevant community and/or healthcare resources that help support participant’s theory of change and effective and efficient medical utilization.
* Educates members and coaches to a healthy lifestyle according to established criteria.
* Establishes and maintains good working relationships with physicians, hospital staff, allied provider contacts, clients and families.
* Directs member to network providers, community resources, online resources and employer sponsored services according to the needs of the client.
* Coordinates and facilitates for acute medical and resource needs.
* Coaches the client utilizing motivational interviewing techniques.
* Monitors the effectiveness of care management plans in achieving quality, cost-effective outcomes, through ongoing communication with clients, families, physicians, and other providers, as well as medical record review and/or onsite client evaluation. Facilitates changes in care plans as indicated.
* Assures that Medical Director and departmental management are informed of care status according to established procedures. Seeks direction on medical or administrative issues as needed. Documents according to accepted medical record standards consistently and thoroughly.
* Provides documentation as needed to ensure proper claims payment.
* Effectively assess, coach and graduate clients from care, resulting in appropriately managed caseloads.
* •Maintains open lines of communication within the organization.
* Is familiar with and functions within national Health coaching and Care Management standards.
* Manages care in a compassionate, quality, cost effective manner.
* Fosters a team relationship with other department staff.