Case Manager

About the role

The position provides Case Management services for TRICARE beneficiaries. The Case Manager is responsible for screening referrals for Case Management and performing a comprehensive assessment. The CM develops and implements an individualized Care Plan and is responsible for monitoring for effectiveness and desired outcomes. Reviews and performs reassessments as needed to ensure identified needs are addressed. CM is responsible for reviewing and processing authorization and referral requests according to policy. Case Managers are responsible for reviewing and being knowledgeable regarding the scope of practice of their state of licensure.

Responsibilities

• Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice.
• Screens beneficiary needs and circumstances with predetermined program criteria to determine appropriateness for case management.
• Identifies beneficiaries at high-risk for significant adverse health outcomes and with high-cost, clinical and psychological factors impacting care.
• Documents the process by providing the case management enrollment information and acceptance letter to the beneficiary.
• Provides timely decision of acceptance into the case management program and completes appropriate notifications.
• Completes comprehensive case management assessments.
• Develops individualized case management care plans to assist beneficiaries with obtaining access to quality care in a cost-effective manner.
• Obtains necessary agreements for obtaining protected health information as needed.
• Makes the care plan available to the Primary Care Manager or Behavioral Health provider for information and input.
• Reassesses and monitors care plans for adjustments on a monthly basis, at a minimum, to address newly-identified needs, services, treatment, and funding options.
• Documents changes in the care plan maintained in the medical management system.
• Evaluates case management outcomes, assessing the individual beneficiary's satisfaction and compliance with the care plan.
• Prepares and presents cases involving high-profile or sensitive issues to the Medical Director for review.
• Functions as an advocate for the beneficiary by ensuring access to necessary care and maintaining Beneficiary’s safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process.
• Supports beneficiaries by providing TRICARE and community resource information and internal care referrals as needed to meet care plan goals.
• Understands, administers the TRICARE Specialty Program benefits, including program registration, enrollment, authorizations, and screening for high risk factors indicating appropriateness for catastrophic case management services.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs.
• Makes decisions regarding the utilization of TRICARE specialty programs and manages the utilization of these programs