Create a positive experience and relationship with the member Help member set goals and develop a care plan to achieve those goals Proactively engage the member to manage their own health and healthcare Support the member to improve their wellbeing by staying out of the hospital, and attend regular visits to their primary physician As needed, help the member engage with m

Communicate and disseminate information to members and families to identify concerns and remove barriers that affect service delivery or member satisfaction Attend community events representing the health plan by offering education on Medicaid benefits and community resources to members and families Support Dual Special Needs (DSNP) members by outreaching to individuals t

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Intake of provider, care coordinator, and Continuity of Care HCBS (home and community based service) assisted technology and environmental modifications authorization requests Review and processing of all HCBS service authorization requests Engage with providers and initiation/follow up on requests for information Engage with the National Letters Team to complete mailing

Serve as primary care manager for elderly and/or disabled members who live in individual housing, community based housing (ALF or CLS homes) or nursing facilities Engage members and/or their families face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) n

Serve as primary care manager for elderly and/or disabled members who live in individual housing, community based housing (ALF or CLS homes) or nursing facilities Engage members and/or their families face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) n

Conducts clinical skills competency assessment and training of newly hired Medical Assistants and LPNs, annual competency assessment of Medical Assistants and LPNs, and maintains associated training files and checklists Maintains log of Incident and First Responder Reports, conducts related research and follow up Collaboration and effective communication skills with clini

Assist with programs designed to ensure proper application of contracted rates and reimbursement policies for company affiliates Analyze claims, pre and post payment, to ensure proper pricing of contracts, reimbursement policies and procedures Review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors Recommend system

Provide back up support to PROS PAL Builder Building payment appendices in PROS PAL via clauses, variables etc. based upon MS Word Drafting and Training Tools. This requires adherence to established formatting and naming convention guidelines Support payment appendix edits in both production and administrative modules Participate in PROS PAL template Peer Reviews Provide

Community Liaison to the Probation, Court system, Detention and Corrections departments Justice Reach in Program Court Order Treatment Program Resource program information for provider and member materials and website Reporting requirements of enrolled adult members who are involved in the justice system Coordinate members in the Justice Reach In Program who are incarcera

Provide a complete continuum of quality care through close communication with members via on phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels Assist members with the transition from a care facility back to their home Providing full Case Management services for disabled

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify the plan of care, as appropriate, based upon reassessment, change in prescriber orders, the patient's

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify the plan of care, as appropriate, based upon reassessment, change in prescriber orders, the patient's

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