Location: Geneva,NY, USA
Role & Responsibilities: Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business. Develop a working relationship with the PCP to be able to contact and discuss the care of the member with them. Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team. Identify the risk factors and assign the risk category to the member. As part of Care Management team, develops a formal care plan for all services needed for the member, including the member's disaster plan. Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary. Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions. Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care.