Case Manager I - Remote - Cincinnati/Columbus, OH

Essential Functions:

• Provides case management services to members with chronic or complex conditions including:
  • Proactively identifies members that may qualify for potential case management services.
  • Conducts assessment of member needs by collecting in-depth information from Company s information system, the member, member s family/caregiver, hospital staff, physicians and other providers.
  • Identifies, assesses and manages members per established criteria.
  • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
  • Performs ongoing monitoring of the plan of care to evaluate effectiveness.
  • Documents care plan progress in company's information system.
  • Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
  • Measures the effectiveness of interventions to determine case management outcomes.
  • Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Company members.
  • Conducts face to face or home visits as required.
  • Participates in Interdisciplinary Care Team (ICT) meetings.
  • Assists orientation and mentoring of new team members as appropriate.
  • Maintains professional relationships with provider community and internal and external customers.
  • Conducts self in a professional manner at all times.
  • Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
  • Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
  • Complies with required workplace safety standards.

Knowledge/Skills/Abilities: