This position works collaboratively with the health care team to manage and coordinate care for members that have social needs in order to ensure quality and cost-effective patient-centered care.
He / she works directly with members / clients as well as with staff, managers, internal and external customers.
Responsibilities include, but are not limited to, the following :
- Under the direction of a Medical Case Manager, performs ongoing care coordination activities. This includes : Conducting outreach Completing HRA and initial health screening Providing telephonic initial screen of non-medical needs, coordinates services and makes appropriate referrals Providing information to members / clients and / or their families regarding social and community support Providing assistance with calls to various social service agencies as appropriate Off site visits (such as but not limited to home, hospital or community health centers or other community agencies) as necessary or required Providing assistance in obtaining access to care and services and making appointments Providing assistance in obtaining medically necessary DME Directing members / clients to internal departments as appropriate Managing a case load of identified and / or assigned members Providing comprehensive documentation of all activities and contacts in CMAQE or appropriate software system
- Assists Behavioral Health Case Manager in coordinating community resources as appropriate
- Participates in the development and maintenance of community resource database
- Collaborates with and provides support to Medical Case Managers as necessary
- Calculates cost savings that may result from interventions, where an alternative level of care, service or resource has been identified and / or arranged
- Takes responsibility for, identifies, and, pursues opportunities for professional development
- Recommends and participates in the development of program improvements and QI activities
- Serves as resource to respond to questions from ancillary departments within Neighborhood
- Participate in communities as assigned
- Provides cross coverage as assigned by Supervisor
- Participates in Outreach / Marketing activities as needed and appropriate
- Maintain up-to-date knowledge of resources in Rhode Island
- Other duties as assigned
- Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company.
This position must exercise due diligence to prevent, detect and report unlawful and / or unethical conduct by fellow co-workers, professional affiliates and / or agents
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This includes: Conducting outreach Completing HRA and initial health screening Providing telephonic initial screen of non-medical needs, coordinates services and makes appropriate referrals Providing information to members/clients and/or their families regarding social and community support Providin...
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