Provides support for care management and care coordination activities and collaborates with a multidisciplinary team to coordinate the integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to the overarching strategy to provide quality, cost-effective member care.
**Essential Job Duties:**
+ Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. + Develops and implements care plans in collaboration with the member, caregiver, physician, and/or other appropriate healthcare professionals and the member’s support network to address member needs and goals. + Conducts telephonic, face-to-face, or home visits as required. + Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and sug...