Pay Range: $35/hr -$40/hr

Benefits:
The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, (paid time , paid sick and safe time , hours of paid vacation time, weeks of paid parental leave, paid holidays annually - AS Applicable)

About the Role

• This position is responsible for the assessment, reassessment, care planning, and coordination of care and services, including ongoing monitoring of an effective person-centered care plan, member education, and care management.
• The role involves conducting initial and concurrent reviews for prior authorization of higher levels of care against medical necessity criteria.
• The position requires the development of individualized care plans for high and moderate stratified members in various health markets.
• The role also includes overseeing the work of the assigned care support team and collaborating with non-licensed support staff to meet standards of care and performance.

Responsibilities

• Accountable for all Care Management activities for assigned high and moderate members with behavioral health conditions requiring intensive interventions and oversight.
• Provides telephone triage, crisis intervention, and prior authorizations for select members with high and moderate needs.
• Conducts comprehensive health risk assessments, including psycho-social, physical, medical, behavioral, environmental, and financial parameters.
• Develops, documents, implements, and communicates patient-centered care plans addressing social, physical, mental, emotional, spiritual, and supportive needs.
• Educates providers, supporting staff, members, and families on care management roles and health strategies with a member-focused approach.
• Oversees appropriate rendering of services during transitions in care or transition to home care, and manages work assigned to the care support team.
• Implements, coordinates, and monitors strategies to improve health and quality of life outcomes for members and families.
• Acts as an advocate for members' care needs by identifying and addressing gaps in care. 
• Performs ongoing monitoring of members' care plans and measures the effectiveness of interventions.
• Assesses and reviews plans of care regularly to identify gaps and trends to improve health and quality of life outcomes.
• Works with members and the interdisciplinary care plan team to adjust plans of care as necessary.
• Facilitates a team approach to ensure appropriate interventions and cost-effective delivery of quality care and services across the continuum.

Education Qualification

• A degree in a relevant healthcare field is required.

Required Skills

• Clinical knowledge and understanding of best practices.
• Ability to conduct comprehensive health risk assessments.
• Strong communication skills for educating providers, staff, members, and families.
• Experience in developing and implementing patient-centered care plans.
• Ability to oversee and manage a care support team effectively.
• Advocacy skills to identify and address gaps in care.
• Ability to monitor and assess the effectiveness of care plans and interventions.
• Team facilitation skills to ensure cost-effective delivery of quality care.