Address
Form of workJob Duties:
The Care Manager develops, facilitates, monitors, and communicates a care plan in partnership with the member, their family or significant other, primary caregiver, the primary and/or the attending physicians, and various providers. Using the assessments and interview done by the Assessment Nurse, the Care Manager identifies the risk factors, strengths, challenges, and service needs of the member as they strive to keep them safe and well in their community setting.
Scope of Role & Responsibilities:
• Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business.
• Develop a working relationship with the PCP to be able to contact and discuss the care of the member with them.
• Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team.
• Identify the risk factors and assign the risk category to the member.
• As part of Care Management team, develops a formal care plan for all services needed for the member, including the member’s disaster plan.
• Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary.
• Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
• Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care.
• Prior approve request for additional services based on assessments and using evidencebased standards refer denial, reduction, or limitation of service request to Medical Director.
• Assist members with the coordination of services both within and outside networks as appropriate. Includes facilitating discharge from acute setting and alternate settings.
• Provides Care Coordination through continuum of care.
The Care Manager develops, facilitates, monitors, and communicates a care plan in partnership with the member, their family or significant other, primary caregiver, the primary and/or the attending physicians, and various providers. Using the assessments and interview done by the Assessment Nurse, the Care Manager identifies the risk factors, strengths, challenges, and service needs of the member as they strive to keep them safe and well in their community setting.
Scope of Role & Responsibilities:
• Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business.
• Develop a working relationship with the PCP to be able to contact and discuss the care of the member with them.
• Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team.
• Identify the risk factors and assign the risk category to the member.
• As part of Care Management team, develops a formal care plan for all services needed for the member, including the member’s disaster plan.
• Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary.
• Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
• Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care.
• Prior approve request for additional services based on assessments and using evidencebased standards refer denial, reduction, or limitation of service request to Medical Director.
• Assist members with the coordination of services both within and outside networks as appropriate. Includes facilitating discharge from acute setting and alternate settings.
• Provides Care Coordination through continuum of care.
