Job Family: Care Management
Country: United States of America
FLSA Status: United States of America (Exempt)
Location: Columbia MD 21046; 6950 Columbia Gateway Drive
Provides care coordination to members with behavioral health conditions identified and assessed as requiring interventions and oversight including multiple clinical, social and community resources. This role promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction.
- Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
- Communicates and develops the treatment plan, and serves as a point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services).
- Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member's care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.
- Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes; works with members to adjust plan of care, when necessary.
- Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services.
- Facilitates a team approach to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
- Provides assistance to members with questions and concerns regarding care, providers or delivery system.
- Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
- Generates reports in accordance with care coordination goals.
- Complies with URAC and NCQA standards for Case Management services.
- Assists with orientation and mentoring of new team members as appropriate.
This position is for Columbia, MD.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled