Analyst Case Management, Field - Must live in Louisiana

Evaluation Of Members

Using care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.

Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.

Enhancement Of Medical Appropriateness And Quality Of Care

Uses a holistic approach to consult with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives.

Presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.

Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Helps member actively and knowledgably participate with their provider in healthcare decision-making.

Monitoring, Evaluation And Documentation Of Care

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.