Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines; ensure compliance with local, state, and federal regulations Assess patients prior to initiation of home care service for appropriateness of services prescrib

Extensive work experience within own function. Work is frequently completed without established procedures. Works independently. May act as a resource for others. May coordinate others' activities. Extensive work experience within own function. Applies knowledge/skills to a range of moderately complex activities. Demonstrates great depth of knowledge/skills in own functio

Manage assigned member caseload telephonically Complete home engagement visits, when telephonic outreach attempts (3), are unsuccessful. Create a positive experience and relationship with the member Keep the member out of the hospital by supporting regular visits to their primary physician Keep member actively engaged with their primary physician Support the member to ens

Make outbound calls and receive inbound calls to assess members' current health status Make referrals to outside sources Identify gaps or barriers in treatment plans Provide patient education to assist with self management Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condit

Responsible for conducting telephonic or face to face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information from Member/family identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long term services and sup

Make calls to qualified members to provide information and answer questions about health plan programs. Provide "best in class" customer service to enrollees Meet established productivity, schedule adherence, and quality standards while maintaining good attendance. Identify, qualify, and engage members into the most appropriate health and wellness programs to meet their n

Visit members in the hospital prior to discharge Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels Assist members with the transition from a care facility back to th