Offer telephonic case management to all members successfully contacted
Provide assistance with locating Behavioral Health providers and scheduling appointments as needed
Educate member on the importance of medical and behavioral health follow-up
Educate member on available resources including Value Added Benefits (transportation, housing, non-traditional services) and after hours resources, including Live Health Online (Telehealth tool that will provide members with a convenient way to have live video conversations with a doctor, get a diagnosis, and receive treatment for common urgent care-type health conditions; include video visits with in-network licensed Psychologists, Therapists and board certified Psychiatrists)
Collaborate with member, LAR, and community supports as needed
Anticipated work schedule:
Monday-Friday 8AM-5PM CST
Responsible for ensuring that appropriate member treatment plans are followed on less complex cases and for proactively identifying ways to improve the health of our members and meet quality goals.
Primary duties may include, but are not limited to:
Coordinates follow-up care plan needs for members by scheduling appointments or enrolling members in programs.
Assesses member compliance with medical treatment plans via telephone or through on-site visits. Identifies barriers to plan compliance and coordinates resolutions.
Identifies opportunities that impact quality goals and recommends process improvements. Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider.
Coordinates identification of and referral to local, state or federally funded programs.
Coaches members on ways to reduce health risks.
Prepares reports to document case and compliance updates.
Establishes and maintains relationships with agencies identified in appropriate contract.
Requires a high school diploma; 1 year of related experience; or any combination of education and experience, which would provide an equivalent background.
Certified nurse assistant or certified medical assistant and/or BS/BA degree in a related field preferred.
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Job ID: 694336
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