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- Through the use of care management tools and information/data review, conducts comprehensive
- Identifies high risk factors and service needs that may impact member outcomes and care planning
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and
- Provides coaching, information and support to empower the member to make ongoing independent
- Helps member actively and knowledgably participate with their provider in healthcare decisionmaking.
- Utilizes case management and quality management processes in compliance with regulatory and
Healthcare case manager - Topeka, United States - US Tech Solutions
Description
Position Summary:
This will be a full-time telework role in Kansas, however, will require 50-75% travel for face-to-face visits in assigned area once COVID restrictions are lifted.
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Healthcare.
Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support andeducation for members through the use of care management tools and resources.
Responsibilities:
meeting needs by evaluating member's benefit plan and available internal and external programs/services.
obtain multidisciplinary review in order to achieve optimal outcomes.
Experience:
Education:
behavioral health, social services, or human services field.
Case Management