The Care Manager plans, implements, and oversees care plans for high-risk members to improve the coordination and accessibility of health services. They collaborate with interdisciplinary teams and community providers to ensure quality care while managing costs and maintaining accurate records.
The Care Coordinator provides administrative and clinical support to the care management team by facilitating access to medical and community resources for members. They are responsible for documenting encounters, conducting health risk assessments, and coordinating care transitions between providers and members.
The Medical Director will lead the Medical Management Program and provide leadership for Health Management Teams. Responsibilities include supervising utilization and quality management, conducting clinical case reviews, and interacting with providers to ensure standards of care.
The Pharmacy Benefit Coordinator supports clinical outreach and HEDIS adherence initiatives to improve member healthcare outcomes and safety. They perform administrative tasks, manage pharmacy benefit implementation, and serve as a liaison between members, providers, and the PBM vendor.
