Job Description

**100% REMOTE OPPORTUNITY**

Makes timely telephonic care management calls based on risk level.

Resolves and coordinates complex issues and member complaints impacting the delivery of services.

Provides health education to member/caregiver.

Assess SDoH and provide care coordination to reduce/remove barriers of care to include ability to allow for changing levels of care based on assessments, trigger events and program data/reports.

Identifies member safety issues and intervenes as necessary or refers to appropriate resources, such as community linkages, dietary, therapy (PT/OT/ST), HHA services, behavioral health, and DME.

Coordinates the delivery of high quality, cost-effective care based on a customized population model of care supported by evidence based clinical practice guidelines.

Advocates for the member/caregiver to obtain the health care and other services needed to optimize their quality of life.

Utilizes the Care Management process to set priorities, plan, organize and implement interventions that are goal directed towards self-care outcomes and the transition to independent status.

Promotes adherence to the physician treatment plan by providing education, coaching and support.

Educates, coordinates, and provides resources to reduce inappropriate utilization of emergency room (ER) and hospital service.

Increases utilization of primary care, specialty care, preventive health and guideline-based treatments including proper pharmacotherapy within network, as appropriate.

Participates in interdisciplinary team (IDT) meetings and provide input on customer service-related activities.

Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Ensures compliance with payors’ policies and procedures as well as all Federal and State regulations.

Interprets and implements the firm's Health policies, state and federal regulations.

Company Description

We are a dynamic recruitment firm dedicated to transforming the talent acquisition landscape by bridging exceptional candidates with innovative organizations. Our mission is to go beyond traditional recruitment, acting as strategic partners who understand that talent is the cornerstone of organizational success.

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