at Highmark Health in Home, United States
This job works directly with providers in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted related to quality and care costs. The incumbent’s responsibilities could include working in a physician’s office, visiting physician practices on a routine basis, working within a hospital setting and/or assessing and coordinating member’s care within the member’s home. Helps members to coordinate care and navigate the healthcare system by recommending and/or implementing interventions related to the improvement of medical care and costs.
+ Conduct member-facing clinical assessments that address the health and wellness needs of members using a broad set of clinical and motivational interviewing skills with the goal of impacting members’ self-management skills and positive behavior changes which will ultimately positively impact member satisfaction and care costs.
+ Serve as a subject matter expert to both internal and external sources (e.g. providers, regulatory agencies, UM and policy.) to provide education, consultation and training when indicated.
+ Serve as a resource to guide, mentor and counsel others in regard to understanding the drivers of health care costs to improve member outcomes related to Plan benefits and resources.
+ Collaborate, coordinate and communicate with the member’s treating provider(s) in more complex clinical situations requiring clinical and psychosocial intervention.
+ Develop/implement case or condition-specific plans of care and/or intervention plan, as needed, that can become a part of the member’s EMR or medical record to establish short and long-term goals.
+ Establish a plan for regular contact (face-to-face as often as possible) with each member and/or provider to monitor progress toward goals, provide additional education and evaluate the need for modification or change in the plan of care.
+ Proactively incorporate lifestyle improvement opportunities and preventive care into member interactions and coaching.
+ Collaborate with the appropriate individuals to offer solutions to refine and improve existing practices or participates in developing performance improvement processes that will enhance member outcomes and operational performance/excellence as well support all strategic initiatives including Health Care Reform and STARS initiatives.
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