The supervisor oversees the daily operations of the 24/7/365 PartnersACCESS call center, providing clinical and administrative leadership to staff. They are responsible for scheduling, performance evaluation, data analysis, and ensuring compliance with state and federal accreditation standards.
The Care Manager serves as the primary point of contact for members with I/DD, facilitating interdisciplinary team meetings and developing person-centered care plans. They are responsible for navigating complex systems and providing holistic support to ensure members achieve their health and wellness goals.
The Care Manager serves as the primary point of contact for individuals with I/DD, facilitating interdisciplinary team meetings and developing person-centered care plans. They are responsible for navigating complex systems, including Medicaid regulations, to ensure members receive holistic support and access to necessary services.
The reviewer evaluates medical necessity and appropriateness of requested services against established clinical guidelines. They also consult with providers and physicians to manage authorization requests and communicate adverse decisions to enrollees.
The position evaluates the medical necessity, appropriateness, and efficiency of requested services against established clinical criteria. Responsibilities include reviewing authorization requests, consulting with providers, and communicating adverse decisions to enrollees and providers.
The Care Manager serves as the primary point of contact for individuals with I/DD, facilitating interdisciplinary team meetings and coordinating holistic support. They are responsible for assessing member needs to develop and implement Person-Centered Care Plans while guiding members through life transitions.
The reviewer evaluates the medical necessity, appropriateness, and efficiency of requested services against established clinical guidelines. They also communicate authorization decisions to providers and enrollees while managing complex caseloads.
The Care Manager serves as the primary point of contact for individuals with intellectual and developmental disabilities, facilitating holistic, team-based care. They assess member needs to develop person-centered care plans and navigate complex health and social service systems.
The Care Manager serves as the primary point of contact for members with I/DD, facilitating interdisciplinary team meetings and developing person-centered care plans. They provide holistic support by navigating complex healthcare systems and connecting members to necessary community services and providers.
The MHSU Care Manager provides proactive intervention, treatment planning, and care coordination for individuals receiving mental health and substance use services. This role involves collaborating with community stakeholders and hospitals to ensure members receive appropriate care and support services.
The Care Management Nurse Consultant provides physical health expertise and proactive consultation to care management teams to support individuals with complex behavioral and intellectual health needs. This role involves facilitating medication reconciliation, monitoring quality of care, and providing direct support through clinical huddles and care team meetings.
