Case Manager

Enhancement of Medical Appropriateness and Quality of Care :

• Using holistic approach consults with case managers, supervisors, Medical Directors and / or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and / or healthcare needs.
• Utilizes influencing / motivational interviewing skills to ensure maximum member engagement and promote lifestyle / behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make

ongoing independent medical and / or healthy lifestyle choices.

Monitoring, Evaluation and Documentation of Care :