Assessment & Planning
- May conduct comprehensive assessments, which could include physical, psychosocial, and health literacy evaluation, and interprets relevant diagnostic data to identify member and family needs.
- Apply critical thinking skills to analyze complex cases, complete medication reconciliation post-discharge, and determine underlying causes contributing to high costs as applicable. Uses these insights to inform individualized transition/treatment plans and address gaps in care delivery.
- If applicable, partners with and empowers the member to develop an actionable care plan that helps prevent avoidable utilization.
Care Delivery
- Consistently follows through on all essential tasks and completes them within required timeframes to effectively close care gaps.
- Communicate results to internal and external departments and business partners as applicable.
Communication & Education
- If applicable, assesses educational needs of members and families, ensuring clear and sufficient information is provided to facilitate active participation in care gap closure.
Quality Improvement & Leadership
- Engages in quality improvement initiatives, supports leadership in system-level improvements, analyzes dashboard data for program enhancement, and mentors new staff to promote best practices.
Performs all other miscellaneous responsibilities and duties as assigned or directed.

#LI-Hybrid

Care Manager, Medicare Stars

Nearby locations