Our subsidiary is responsible for coordinating care for healthy eligible individuals, those with multiple chronic conditions, pregnant women, and men and women needing family planning. The goal of the program is to ensure an effective and efficient delivery of care. This area works with low income populations to improve the quality of care programs and community outreach.

Primary Responsibilities

 

• Conduct facility, and home visits on assigned recipients in order to complete screenings and assessments to ensure appropriate home based support and services are available
• Provides support to recipients transitioning from one care setting to another by leading or participating in the Transitional Care team, serving as the primary Care Coordinator and addressing clinical needs
• Collaborate with medical, behavioral health and/or community resource providers to create a sound foundation for the care plan
• Consult with the Multidisciplinary Care Team (MCT) to develop and implement patient centered holistic care plans
• Improve recipients or client’s health outcomes by promoting quality assurance
• Ensures timely assignment and completion of care management tasks
• Ensures compliance with state performance metrics and goals
• Reduce inappropriate utilization and costs associated with emergency department and hospital inpatient services
• Supports staff and Primary Care Providers (PCPs) to ensure appropriate services are provided to enrolled EIs or clients
• Supports enhancement of Medicaid services provided to recipients or clients
• Meet our subsidiary and Medicaid requirements for charting and audit requirements
• Accomplishes all assigned job functions in a manner that optimizes departmental effectiveness while maintaining confidentiality