a. Proactively coordinate care for high risk members and/or members that are identified with potential high risk, complex conditions through focused intervention and effective planning techniques. This includes assessing members to identify care needs, barriers & interventions. In collaboration with the member and the members health care delivery team, create, manage and update individualized intervention-based care plans.
b. Effectively engage members in the participation of the case management plan and educate members on their accountability and expected outcomes, including services and benefits appropriate to their current medical status.
c. Monitor results and trends and make recommendations to leaders/advisory team/groups as appropriate regarding change.
d. Actively research and stay abreast of appropriate resources and/or programs that may help to improve the health of the member. Collaborate with and facilitate referrals to providers, community resources/programs and Wellmark programs as necessary.
e. Meet caseload expectations for work area assigned through predetermined case identification logic. Accepts referrals from other programs and from within the advanced care management area. Meet both quality assurance and production metrics as established by the advanced care management unit.
f. Document case findings accurately, consistently and timely by following the standard work guidelines and policies to support internal and external processes.
g. Collaborate with and facilitate referrals to providers, community resources/programs and Wellmark programs to improve the health of the member. Comply with regulatory standards, accreditation standards and internal guidelines remain current and consistent with the standards pertinent to the Case Manager team.
h. Provide education to the member on services and benefits appropriate to their current health status and needs regarding their support care. Reduce barriers in the health care delivery system to ensure the member has access to and uses appropriate, quality, health care services by matching the services to the members needs, avoiding duplication of effort and improving provider/member communication.
i. Participate in cross-collaboration among health and care management teams and stakeholders across divisions as required to provide optimal service to the member.
j. Other duties as assigned.