Medical Case Manager - Transition of Care (New Castle County, DE)

Job description

Company: Highmark Inc. Job Description: JOB SUMMARY This job assures that members with complex medical and/or psychosocial needs have access to high quality, cost-effective health care. Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare services. Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts. Follows established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the member’s care and progress across the continuum of care. Facilitates and/or participates in interdisciplinary and/or interagency meetings, when necessary, to facilitate coordination of services/resources for members. ESSENTIAL RESPONSIBILITIES: Communicate effectively while performing customer telephonic interviewing and communication with external contacts. Communicate effectively while interacting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts. Ma...