Utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote optimal, cost-effective outcomes. Also provides support and resources for case and disease management staff. Completes member assessments as appropriate by collecting and analyzing information across the seven domains of health and develops and implements individualized care plans with appropriate interventions in a culturally sensitive way. Uses standardized tools to complete assessments focusing on functional, financial, support system, psychosocial and cognitive and environmental realms. Demonstrates a strong understanding of the grieving process and is able to work comfortably with these members. Monitors effectiveness of plan of care by gathering sufficient information from relevant sources in order to intervene, as appropriate, to support the member’s choice of care, crisis intervention, improvement of health outcomes and end-of-life care. Determines appropriate intervals for monitoring plan of care. Utilizes internal, community and other members of the healthcare team to maximize outcomes. Responsible for prioritizing interventions based on clinical, emotional or social considerations. Educates and works with members or their families at different educational and health literacy levels. Utilizes psychosocial knowledge and critical thinking skills to individualize evidence based interventions. Assesses the member’s need for education and tailors teaching to the member’s knowledge level and learning style. Responsible for meeting targets for program performance, such as monthly productivity and annual caseload requirements as mutually agreed to by management team to maximize program value. Schedules time effectively. Works with minimal supervision. Handles multiple projects simultaneously. Prioritizes work appropriately. Is able to adapt to changes in job requirements. Contributes to meeting department goals and strives for difficult/attainable personal goals.
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Job Type
Full-time
Career Level
Mid Level