Position Summary

• Analyst, Case Management (ACM) drive and support care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). 
• The ACM utilizes critical thinking and judgment to collaborate and inform the care management/care coordination process in order to facilitate appropriate healthcare outcomes for assigned members.
• They provide care coordination, support and education for members through the use of care management tools and resources.

Position Responsibilities

• Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services. 
• Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate.  
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an 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. 
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access. 
• Coordinates and implements assigned care plan activities and monitors care plan progress. 
• Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives. 
• Presents cases at case conferences/rounds to obtain multidisciplinary review in order to achieve optimal outcomes. 
• Works collaboratively with the members’ interdisciplinary care team. 
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals. 
• Identifies and escalates quality of care issues through established channels.  
• Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. 
• Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation). 
• Educates members about available resources and services such as Oklahoma value-added benefits and assisting the member in accessing those resources and services. 
• Facilitates clinical hand offs during transitions of care. 

Required Qualifications

• 3+ years of related professional experience includes acting as a care manager, rehabilitation specialist, health specialist, or social services coordinator.
• 3+ years of experience in the Healthcare field.
• 3+ years of experience working with Microsoft Office applications.

Preferred Qualifications

• Case management and discharge planning experience preferred 
• Managed Care experience preferred 
• Licensed Social Worker

Education

• Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (psychology, social work, marriage and family therapy, counseling).