Job Details

Serve as the primary care manager for dual eligible members. Engage people face-to-face and/or telephonically to complete a comprehensive needs assessment or wellness assessment (as appropriate), including assessment of medical, behavioral, functional, cultural, and social drivers of health (S - Do. H)Develop and implement individualized, person-centered care plans inclusive of goals, opportunities and interventions aligned with a person's readiness to change to support the best health and quality of life outcomes by meeting them where they are in their health journey. Partner and collaborate with the internal care team, providers, and community resources/partners to implement care plans and remove obstacles so the member can successfully stay in or return to the community (when appropriate)Assist members with obtaining necessary HCBS supports and services. Provide referral and linkage as appropriate and accepted by the individual being served (may include internal consult opportunitie...Field Service, Coordinator, County, Remote, Health, Service, Retail, Healthcare