Lead Care Manager - Fresno, CA
1 day ago
Job summary
The Lead Care Manager works in collaboration and continuous partnership with chronically ill or high-risk members and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources to coordinate services ensure seamless experience for the member non-duplication of services engage eligible members oversee provision of ECM services implementation of the care plan offer services where the member lives seeks care or finds most easily accessible within Plan guidelines connect member to other social services supports the member may need including transportation advocate on behalf of members with healthcare professionals use motivational interviewing trauma-informed care harm-reduction approaches coordinate with hospital staff on discharge plans accompany member to office visits as needed according to Plan guidelines monitor treatment adherence including medication provide health promotion self-management training promote timely access appropriate care increase utilization preventative care reduce emergency room utilization hospital readmissions increase comprehension culturally linguistically appropriate education create promote adherence to a care plan developed coordination with the member primarycare provider family/caregivers manage relationships tertiarycare providers transitionsincare referrals increase members ability for self-management shared decision-making connecting members relevant community resources enhance member health wellbeing reduce healthcare costs connect follow up with members family/caregivers providers community resources via face-to-face secure email phone calls text messages other communications serve as contact point advocate informational resource for members caret team family/caregivers payers community resources work with members plan monitor care assess memberts unmet health social needs develop carplanwithmemberfamilycaretproviders evaluate effectiveness monitor memprogresstime facilitate changes as needed create ongoing processes formembersfamilycaret determine request level caresupportthey desire at any given time facilitate accessappropriate medical specialty providers educate about relevantrcommunityresources faciltateattendmeetingsbetweenmembersfamilycared caretteampayerscommunityresourceascneeded cultivate supportprimarycarespecialistproviderco-mangement timlycommunicationinquiryfollow-upintegrationofinformationintocareplanntransitionsincareandreferrals assistidentificationhighriskmemembersaddthememberregistryorflaginehr attendallleadcarmanagertainingcourseswebinarrendetings providfeedbackforimprovementofecmprogram offer servicewhere thememberlivesseekscarerfindsmostrateasilyaccessiblewithinmedi-cal-managed-carehealthplansguidelines engagememergiblemembers arrange transportaion callmemtfaciltatemembervistwiththeecm-lead-carmangerr>
Job description
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