Case Management Functions
- Conduct a comprehensive assessment of member’s health care needs and work closely with the member, the member’s assigned physician, community agencies and other healthcare providers in developing a plan of care to help the member achieve his or her health care goals.
- Work closely with the member and the health care team to explain a member’s covered health care benefits, and facilitate communication and collaboration among all providers to ensure continuity and accessibility of the member’s care.
- Educate member on his or her health conditions and medications, and refer member to community agencies and resources when necessary to ensure access to high quality medical care.
- Advocate for the member, encourage appropriate use of health care services, and make reasonable efforts to facilitate positive outcomes so that member’s healthcare goals are met.