Overview:
Department: Value Based Care
Location: Remote - Occasional in-office meetings required.
Hours: Full-Time; 40 Hours weekly
Open to: RN - LPN - Very Experienced Medical Assistant

• Analyze data collected from the predictive modeling tools to identify eligible patients for the Case Management Program.
• Enroll and manage a case load of patients with complex medical needs, completing case management attestations and initial assessments in accordance with health plan requirements.
• Develop individualized case management plans with prioritized goals and appropriate interventions in compliance with the risk stratification level requirements. In addition, complete all documentation, member communications, and case closures per policies and procedures.
• Proficient in knowledge of current Case Management Standards
• Coordinate Health Care Services with appropriate physicians and health care providers.
• Manage and provide a comprehensive summary and log of all active Case Management Cases as required by the UM/QA Committee and/or Health Plan.
• Act as a resource for Utilization Management Staff, physicians, office staff and Patients.
• Assist with the evaluation and amendment of Case Management Policy and Procedures
• Attend continuing education sessions and training relating to your job functions as required.
• Perform additional duties/tasks as assigned