Case Manager

About the role

Provide Case Coordination to Medicaid Members. 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 and education for members through the use of care management tools and resources.

Essential Functions

• Evaluation of Members:-Through the use of care management tools and information/data review, conducts
• Enhancement of Medical Appropriateness and Quality of Care:- Using holistic approach consults with case managers,
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Monitoring, Evaluation and Documentation of Care:- Utilizes case management and quality management processes in
• Demonstrates skills of flexibility, independence, organizational ability, willingness to work with a team and passion for assisting class members of the Colbert Consent Decree.

Additional Information

All your information will be kept confidential according to EEO guidelines.