Position Purpose: 
Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination. 
 
Education/Experience: 
Requires a Bachelor’s degree and 2 – 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure. 
 
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 
 
 
License/Certification: 
Current state’s clinical license preferredEvaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome 
 
Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care 
 
Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans 
 
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner 
 
May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate 
 
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators 
 
May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate 
 
May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits 
 
Other duties or responsibilities as assigned by people leader to meet the member and/or business needs 
Performs other duties as assigned 
 
Complies with all policies and standards

Right to Hire - Patient/Member Services

$18 - $28/hr

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