Medical Case Manager
4 weeks ago
About the Role
This position plays a critical role in ensuring that members with complex medical and psychosocial needs have access to high-quality, cost-effective healthcare. As a Medical Case Manager, you will be responsible for assessing, planning, arranging, coordinating, and monitoring the care of members to facilitate their access to healthcare services.
Key Responsibilities
- Communicate effectively with members, healthcare providers, and internal stakeholders to coordinate care and services.
- Conduct thorough assessments of members' medical and psychosocial needs to develop individualized care plans.
- Collaborate with healthcare providers to ensure that members receive necessary services and interventions.
- Monitor members' progress and adjust care plans as needed to achieve optimal health outcomes.
- Stay up-to-date on relevant medical terminology, diagnostic categories, and disease states to provide informed care coordination.
- Develop and maintain relationships with community resources and healthcare providers to facilitate access to services.
- Participate in interdisciplinary team meetings to coordinate care and share best practices.
- Document all interactions and care coordination activities in a timely and accurate manner.
Requirements
- Bachelor's degree in nursing or social work, or equivalent experience.
- 3-5 years of experience in acute care, managed care, or a related field.
- Experience working with high-risk populations, such as pregnant women or individuals with chronic conditions.
- Strong communication and interpersonal skills, with the ability to work effectively with diverse stakeholders.
- Ability to work independently and as part of a team to achieve shared goals.
What We Offer
Highmark Health is committed to providing a supportive and inclusive work environment that fosters professional growth and development. We offer a competitive salary and benefits package, as well as opportunities for professional advancement and continuing education.
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