Job Summary

Job Duties

• Integrates evidence-based clinical guidelines, preventive guidelines, protocols, and other metrics in the development of treatment plans that are patient-centric, promoting quality and efficiency in the delivery of healthcare for the identified population.
• Develops systems of care that monitor progress and promote early intervention in acute care situations.
• Assists with the design, implementation, and evaluation of the advanced patient centered care model.
• Assesses the healthcare, educational and psychosocial needs of patients or members.
• Designs an individualized plan of care and fosters a team approach by working collaboratively with the patient or member, family, primary care provider, and other members of the health care team to ensure coordination of services.
• Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population.
• Works to appropriately apply benefits and utilization management serving as a resource to the patient or member and healthcare team.
• Maintains required documentation for all case management activities.
• Collects required data and utilizes this data to adjust the treatment plan when indicated.

Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.

Position Details

Education

Experience

Certification(s) and License(s)